View Abstract

A1752 - Improved Detection of COPD and Alpha-1 Antitrypsin Deficiency Screening by Primary Care Physicians Using an Electronic Medical Record Clinical Reminder
Author Block: L. V. Luna Diaz1, B. Hagenlocker2, M. Mirsaeidi2, G. E. Holt2, R. Calderon-Candelario2, M. A. Campos2; 1Jackson Memorial Hospital, Miami, FL, United States, 2Miami VA Medical Center, Miami, FL, United States.
Rationale
Chronic obstructive pulmonary disease (COPD) and alpha-1 antitrypsin deficiency (AATD) are conditions that remain under recognized by clinicians, in particular primary care providers. The goal of this project was to increase both COPD diagnosis and AATD screening in subjects with COPD in a population of veterans attending primary care clinics by using an electronic clinical reminder (ECR) in the electronic medical record.
Methods
The COPD ECR used an algorithm and dialog that first focused on screening for COPD risk, followed by spirometry ordering, COPD confirmation and AATD screening. COPD risk was determined using the COPD Population Screener (COPD-PS). The ECR prompted spirometry orders for subjects at high risk for COPD (COPD-PS of 5 points or more) or pulled in results of a prior test. Physicians had to acknowledge if the spirometry results were consistent with airflow obstruction (COPD confirmation), in which case the reminder suggested AATD screening and facilitated ordering through the central laboratory. The reminder appeared in all patient charts as a mandatory item and disappeared once completed. For analysis, actions taken on each step of the COPD ECR algorithm were retrieved from CPRS. In addition, charts of high-risk subjects were reviewed to confirm results.
Results
From 2010 to 2016, the COPD ECR was applied to 7,919 subjects older than 35 years (mean 58 ± 11.6 years, 90.1% male) that attended primary care clinics at the Miami VA Medical Center. Overall 14.1% of this population qualified as having high risk for COPD by the COPD-PS, from which only 22% had a prior spirometry. The ECR prompted new spirometry orders in 78.3% of these non-tested high-risk group, confirming the diagnosis of COPD in 47.7% (N=364). Through the reminder, 86% of these new COPD confirmations were tested for AATD. A group of subjects with known COPD (N=527) did not undergo the COPD-PS portion of the reminder but underwent the rest of the algorithm. 43.3% of them had no prior spirometry. Through the ECR, 49% of these subjects had spirometries ordered and showed that 18% had no evidence of airflow obstruction (an incorrect COPD diagnosis).
Conclusion
A clinical reminder in the electronic medical record can markedly improve COPD detection rates and COPD misdiagnoses in the primary care setting. The reminder also increases compliance with clinical guidelines recommending AATD screening of subjects with confirmed COPD.