Checking the Box: The Association between "Problem List Reviewed" and Outdated Diagnoses on the List.

Area of Science:

• Health Informatics
• Clinical Documentation Improvement
• Electronic Health Records (EHRs)

Background:

• Problem lists in EHRs are crucial for high-quality care but often become lengthy and outdated.
• Current policies, like the
• Problem List Reviewed
• attestation checkbox, aim to improve problem list upkeep but are frequently bypassed by clinicians.
• Clinicians may check the attestation box for performance measures without actual review and modification of the problem list.

Purpose of the Study:

• To evaluate the association between the
• Problem List Reviewed
• attestation and the duration of short-term diagnoses on patient problem lists.
• To determine if EHR attestation practices align with the intended goal of maintaining accurate and concise problem lists.

Main Methods:

• A multi-method study utilizing retrospective EHR data from 892,329 patient visits across 24 Federally Qualified Health Centers.
• Included adult patients with at least two primary care visits during the study period.
• Primary outcome: duration of short-term diagnoses on problem lists; Secondary outcome: relationship between duration and attestation.

Main Results:

• Short-term diagnoses persisted on problem lists significantly longer than clinically appropriate (e.g., urinary tract infection: median 443 days).
• For most conditions studied, attestation of
• Problem List Reviewed
• was associated with significantly longer diagnosis duration.
• Chart reviews indicated minimal problem list management during patient visits, despite attestation.

Conclusions:

• The
• Problem List Reviewed
• attestation is not effective in removing short-term diagnoses and may paradoxically increase their persistence.
• Incentive structures based on clinician attestation are counterproductive for maintaining accurate problem lists.
• Improving EHR problem list design and functionality is a more promising approach than relying on attestation checkboxes.