Implementation of Electronic Medical Record Template Improves Screening for Complications in Children with Type 1 Diabetes Mellitus

Abstract

Objective

Health professionals and patients should follow comprehensive screening guidelines to recognize early signs of long-term complications for insulin-dependent type 1 diabetes mellitus (T1DM). The aim of this study is to demonstrate that utilization of electronic medical record (EMR) templates for diabetes management improves adherence to International Society for Pediatric and Adolescent Diabetes (ISPAD) screening guidelines.

Methods

All patients with T1DM who were seen in the outpatient pediatric endocrine clinic (age 0–22 years old) at an urban community-based community hospital during the 2014 calendar year were enrolled in the study (n=49). A retrospective chart review was performed and audited against ISPAD guidelines. An EMR template and order set was then created based on ISPAD screening guidelines with the aim of improving compliance. The templates were implemented in 2015 (initial phase) and 2016 (maintenance phase) and these data were compared to baseline data. A chi-squared test was performed to analyze the differences between the data using SAS version 9.4 (SAS Institute, Inc). A p-value less than 0.05 was considered significant.

Results

Significant improvements (p< 0.05) in screening guideline adherence from baseline to maintenance phase data were found for annual retinopathy (0% to 45%) and neuropathic foot (0% to 64%) exams, screening for microalbuminuria (49% to 79%), celiac disease (6% to 81%), lipids (63% to 86%), and basic metabolic panel (69% to 88%). Of note, thyroid function testing was also increased, but was not statistically significant between the years.

Conclusion

The utilization of EMR templates and order sets for T1DM are valuable tools to aid medical providers in adhering to ISPAD screening guideline.

Keywords:

• type 1 diabetes
• electronic medical record
• screening tool
• disease management
• chronic disease
• benchmarking
• quality improvement
• pediatrics
• standardized documentation

Acknowledgments

We would like to thank Oksana Tatarina-Nulman for her contribution and help with manuscript revisions. The abstract of this paper was presented at the 2018 Pediatrics Academic Society Meeting, “The Use of a Diabetes Electronic Medical Record Template Leads to Improvement of Screening for Complications of Type 1 Diabetes Mellitus in the Pediatric Population” as a poster presentation with interim findings. The poster’s abstract was published in “Meeting Abstracts” in Pediatrics Academic Society, May 2018, 142 (1 meeting abstract) 616; DOI:10.1542/peds.142.1MeetingAbstract.616.

Disclosure

The authors have no conflicts of interest to disclose.