title: An electronic medical record-based intervention to improve quality of care for gastro-esophageal reflux disease (GERD) and atypical presentations of GERD.
abstract: BACKGROUND
  Gastro-esophageal reflux disease (GERD) is common in primary care but is often underdiagnosed and untreated. GERD can also present with atypical symptoms like chronic cough and asthma, and physicians may be unaware of this presentation. We aimed to implement and evaluate an intervention to improve diagnosis and treatment for GERD and atypical GERD in primary care.
  
  
  METHODS
  This was a randomised controlled trial in primary care office practice using a national network of US practices (the Medical Quality Improvement Consortium - MQIC) that share the same electronic medical record (EMR). Thirteen offices with 53 providers were randomised to the intervention of EMR-based prompts and education, and 14 offices with 66 providers were randomised to the control group totalling over 67 000 patients and examining outcomes of GERD diagnosis and appropriate treatment.
  
  
  RESULTS
  Among patients who did not have GERD at baseline, new diagnoses of GERD increased significantly in the intervention group (3.1%) versus the control group (2.3%) (P<0.01). This remained significant after controlling for clustering with an odds of diagnosis of 1.33 (95% CI 1.13-1.56) for the intervention group. For patients with atypical symptoms, those in the intervention group had both higher odds of being diagnosed with GERD (OR 2.02, 95% CI 1.41-2.88) and of being treated for GERD (OR 1.40, 95% CI 1.08-1.83) than those in the control group.
  
  
  CONCLUSIONS
  GERD diagnosis and treatment in primary care, particularly among patients with atypical symptoms, can be improved through the use of an EMR-based tool incorporating decision support and education. However, significant room for improvement exists in use of appropriate treatment.
authors.affiliation: Department of Family Medicine, Medical University of South Carolina, Charleston, SC 29425, USA. playerm@musc.edu
authors.forename: Marty S
authors.initials: MS
authors.lastname: Player
authors.forename: James M
authors.initials: JM
authors.lastname: Gill
authors.forename: Arch G
authors.initials: AG
authors.lastname: Mainous
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Everett
authors.forename: Richelle J
authors.initials: RJ
authors.lastname: Koopman
authors.forename: James J
authors.initials: JJ
authors.lastname: Diamond
authors.forename: Michael I
authors.initials: MI
authors.lastname: Lieberman
authors.forename: Ying Xia
authors.initials: YX
authors.lastname: Chen
mesh_terms: D000328:Adult; D000465:Algorithms; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D005764:Gastroesophageal Reflux / Q000175:diagnosis* / Q000188:drug therapy*; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D011320:Primary Health Care; D011785:Quality Assurance, Health Care / Q000458:organization & administration; D012424:Rural Population; D014505:Urban Population
chemical_list: D005765:Gastrointestinal Agents