Thursday, September 02, 2010

More Evidence Electronic Reminders Can Help Improve Care.

The following appeared a few days ago.

Tracking system can improve follow-up after abnormal Pap test

August 20, 2010 | Bernie Monegain, Editor

BOSTON – Physicians who use an automated, electronic medical record tracking system to follow up on patients with an abnormal Pap test could increase the number of women who achieve diagnostic resolution and do so in less time than using traditional methods, according to new research.

Researchers from Boston University School of Medicine (BUSM) reported their findings in the Journal of General Internal Medicine.

Screening for cervical cancer with a Pap test is only as successful as the follow-up rate for an abnormal result, the researchers said. If a patient has a Pap test, yet does not receive appropriate follow-up for an abnormal result, then the opportunity to prevent or treat pre-cancerous lesions or cervical cancer is missed and the Pap test is ineffective.

The advent of tracking systems provides great potential to address inadequate follow-up on a systemic level, researchers found.

"We developed a tracking system for our internal EMR, and evaluated this tracking system as an intervention to improve adequate follow-up of abnormal Pap tests," said lead author Elizabeth Dupuis, MD, from the Section of General Internal Medicine in the Department of Medicine, and the Women's Health Interdisciplinary Research Center at BUSM.

The BUSM researchers compared abnormal Pap test follow-up rates for the 24 months prior to implementing the tracking system with rates 12 months after its implementation. The evaluation monitored all subjects for 12 months from the date of their abnormal Pap test through diagnostic resolution. Controlling for type of abnormality and practice location, the adjusted time to resolution decreased significantly from 108 days prior to implementing the tracking system to 86 days after implementation.

More here:

This seems to be a very good outcome, ensuring there is no unreasonable delay between a identification of a suspicious result and definitive resolution being achieved in terms of completed follow-up and treatment if needed.

Of course the front end of this is also important – where the EMR identifies patients who need various screening interventions and makes sure they are done – and then – when abnormalities are identified – makes sure the issue is properly and safely resolved.

Another brick in the evidence wall!


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