D3-02 - Utilizing an EHR-based analysis tool to Evaluate a Transdisciplinary Educational Intervention

ABSTRACT

Author(s)

• Sharisse Marie Arnold Rehring, MD, FAAP, Director Medical Education, CPMG and Director Longitudinal Integrated Clerkship, UC SOM, Colorado Permanente Medical Group/University of Colorado School of Medicine
• John Steiner, MD, MPH, Senior researcher, KPCO Institute of Health Research, Colorado Permanente Medical Group
• Andrew Maclennan, MD, Medical Director Clinical Guidelines, Colorado Permanente Medical Group

Purpose/problem statement

The lack of research expertise within CE departments and the lack of data on educational outcomes are barriers to scholarship in CPD. This example will illustrate the application of a scholarly approach to a CE activity though the use of an EHR-based reporting tool to assess educational outcomes. This intervention also exemplifies how interprofessional education in different venues of care facilitates spread of educational messages. Evidence suggests the routine use of antibiotics to treat straightforward conjunctivitis does not lead to faster resolution of symptoms, and potentially creates more harm than benefit through chemical irritation and disruption of the microbiome of the eye.

Approach(es)

A multimodal CE activity to reduce the use of topical antibiotics for conjunctivitis was implemented in Kaiser Colorado. The activity included a 1.5 hour CE intervention, development of an EHR dot phrase for patients on “chat with a doc”, nursing education and protocol revision, system changes to an order set and dissemination of longitudinal take home points. To assess the outcomes of our intervention, we used an EHR reporting tool to assess time trends in antibiotic prescribing for children under age 18 from 12 months prior to the educational activity to 12 months after the activity. Using this reporting tool, we were able to assess changes in different care settings (in person primary care, in person urgent care, and virtual “chat” visits), and prescription of antibiotics by physicians vs. nurses operating under prescribing protocols.

Findings

For the 12 months prior to the educational activity, between 783 and 1699 children per calendar quarter were diagnosed with conjunctivitis, and between 75% and 82% received an antibiotic. In the 12 months after the intervention, between 141 and 482 children per quarter were diagnosed with conjunctivitis, and between 27% and 43% received antibiotics. Nursing protocols no longer allowed for diagnostic prescribing of antibiotics for conjunctivitis. Urgent care clinicians who did not participate in the educational activity continued to prescribe antibiotics at a similar rate before and after the activity.

Discussion (including Barriers/Facilitators if relevant)

Our findings suggest that, by using a reporting tool embedded in the EHR of our health care system, we could demonstrate a large and sustained change in prescribing occurred after this educational intervention which incorporated adult learning theory, proven interventions that make CE effective and system changes at point of care. The conclusions of this evaluation must be viewed cautiously, since we did not account for other factors that may have affected prescribing and did not apply statistical tests or models. However, the magnitude and durability of this effect supports the effectiveness of our educational program, and shows that the ability to assess educational outcomes using built-in reporting tools in EHRs is a novel approach that is available to all organizations that have similar EHR functionality.

Impact/relevance to the advancement of the field of CME/CPD

This study involved a transdisciplinary intervention and “venue sensitive” approach. Nursing education and protocol revision as well as a dot phrase for “chat with a doc” facilitated spread. Reporting tools within the EHR allowed educators to link the timing of the intervention to a sustained change in prescribing.