title: The Development and Implementation of an Electronic Health Record Tool for Monitoring Metabolic Syndrome Indices in Patients with Serious Mental Illness.
abstract: Objectives1. A quality performance improvement (QI) project to implement an electronic screening and monitoring tool to record components of the metabolic syndrome (e-MSD) during clinic visits by persons with serious mental illness (SMI). 2. To encourage psychiatrists to use this tool in their documentation.MethodsWorking with the information technology staff; five psychiatrists developed, tested, revised and embedded the e-MSD tool into the medication management document within the electronic health record. A continuing medical education program on metabolic syndrome was developed, and released to psychiatrists and mental health clinicians. Psychiatrist offices at one clinic were equipped with weighing scales, sphygmomanometers, waist circumference tapes and a QI project was initiated.ResultsAt one month, 9 to 12% of the anthropometric measures (height, weight, body mass index, waist circumference, and blood pressure) were recorded in 974 unique patient encounters, and 1 year later the numbers moved upwards - 15 to 41%. Towards the end of Year 1, a patient care associate was hired to measure the anthropometric measures, and one year later, the documented rates increased to 75-80%. Laboratory recordings (glucose and lipids) remained ≤ 8% throughout the first year, but moved upwards to 25% in Year 2.DiscussionNotwithstanding significant administrative and technical support for this QI project, changing clinician practice to screen, monitor and document metabolic indices in persons with SMI in the ambulatory setting changed significantly after the hiring of a patient care associate. Efforts to obtain laboratory measures in real-time remain a challenge. Next steps include interventions to promote weight loss and smoking cessation in SMI patients, and effective communication with their primary care doctors.
authors.affiliation: Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center. University of Pittsburgh School of Medicine.
authors.forename: Ken
authors.initials: K
authors.lastname: Nash
authors.forename: Frank
authors.initials: F
authors.lastname: Ghinassi
authors.forename: Jaspreet S
authors.initials: JS
authors.lastname: Brar
authors.forename: Abdulkader
authors.initials: A
authors.lastname: Alam
authors.forename: Mary Catherine
authors.initials: MC
authors.lastname: Bohan
authors.forename: Kalyani
authors.initials: K
authors.lastname: Gopalan
authors.forename: Amie
authors.initials: A
authors.lastname: Carter
authors.forename: K N Roy
authors.initials: KN
authors.lastname: Chengappa
keywords: Bipolar Disorder; Electronic Health Record; Metabolic Syndrome; Quality Performance Improvement; Schizophrenia; Serious Mental Illness