27 UTILIZATION OF AN ELECTONIC MEDICAL RECORD (EMR)-INTEGRATED DASHBOARD IMPROVES IDENTIFICATION AND TREATMENT OF IRON DEFICIENCY IN PEDIATRIC INFLAMMATORY BOWEL DISEASE
Authors: Breton Jessica , Yuchen Zhang , Patel Trusha , McDermott Janine , Stevenson Jamie , Schwab Erica , Downing Maura , Maxwell Elizabeth , Siddique Shazia , Grossman Andrew 
Published: January 2020

Background

Anemia is frequently encountered in inflammatory bowel disease (IBD) with studies reporting an even greater prevalence among children (16–72%) than adults (4–67%) at any given time during disease course. Anemia is commonly a result of chronic iron deficiency (ID) and inflammation, with the two conditions often overlapping. Many studies have shown that gastroenterologists underecognize and undertreat these conditions. Moreover, there are currently no pediatric-specific guidelines. To align clinical practice with adult guideline recommendations and evidence-based publications, we developed a quality improvement (QI) initiative incorporating an algorithmic framework for recognition and treatment of iron deficiency anemia (IDA) in pediatric IBD.

Methods

The goals were twofold: improvement in 1) detection and 2) treatment rates of IDA in IBD patients. A multifaceted approach with a series of plan-do-study-act (PDSA) cycles was executed: 1. Public review of our current performance of anemia screening and treatment with all divisional providers (n=60) (11/2017), 2. Development of a new divisional clinical pathway for screening and treatment of IDA in patients with IBD (01/2018), 3. Educational sessions (02-04/2018), 4. Creation of an Epic order set and patient and family education (PFE) (02/2018), 5. Online availability of our pathway (11/2018), and 6. Utilization of an electronic medical record (EMR)-integrated dashboard to track our outcome metrics. A designated coordinator identified patients in the EMR and sent monthly reports to providers based on our automated dashboard which captured the percentage of patients with ordered hemoglobin (Hb) and ferritin, percentage of patients with anemia and/or iron deficiency, and percentage of patients with ordered iron therapy. Baseline data from July 2016 were compared to data after pathway implementation.

Results

In the pre-intervention period (July 2016-November 2017), 73.5% of our outpatient IBD population had a Hb ordered, with anemia prevalence of 36.3%. Only a minority of patients with anemia were being screened for ID (19.3%). Iron supplementation was prescribed in 38.1% of patients with documented anemia. Following the implementation of this QI initiative, rate of patients with biannual Hb testing completed increased to 80.1%, while prevalence of anemia decreased to 32.1%. Significant improvement was observed with screening and treatment rate increasing to 43.1% and 50.4% respectively by July 2019 as shown in Fig. 1–2. Notably, patients with moderate to severe anemia improved significantly from 48.7% to 62.1%.

Conclusion

ID and anemia are commonly underdiagnosed and undertreated in children with IBD. An evidence and expert based pathway combined with implementation of provider-based monthly reports using the EMR to support clinical decision may help increase screening and intervention and decrease rates of anemia prevalence.

https://www.chop.edu/clinical-pathway