title: A quality improvement study to improve inpatient problem list use.
abstract: BACKGROUND
  The problem list is a meaningful use incentivized criterion, and >80% of patients should have 1 problem entered as structured data.
  
  
  OBJECTIVE
  The aim of the present study was to use a series of interventions to increase the use of the problem list for inpatients to >80% as measured by at least 1 hospital problem at discharge.
  
  
  METHODS
  This study was a quasi-experimental time series quality improvement trial. The primary outcome was 80% of medical and psychiatric inpatients with a problem added to the problem list before discharge. Control charts of percentage (p charts) of medical and psychiatric patients with an inpatient problem list at discharge were constructed with three-σ control limits. Control limits were revised after evidence of improvement. The charts were annotated with interventions, including increasing awareness, focused education, and timely feedback in the form of performance graphs e-mailed to providers.
  
  
  RESULTS
  For medical inpatients, use rose from 31% to 97% at its peak in April 2011 and continues to maintain above the goal of 80%. In psychiatry, problem list use rose from 2% initially to an average of 72% after the interventions.
  
  
  CONCLUSIONS
  Significant gains were made with inpatient problem list usage by the medical and psychiatric teams. Our goal ascribed by meaningful use for >80% of inpatients to have a problem at discharge was met after initiation of our series of interventions.
authors.affiliation: Department of Pediatrics-Hospital for Sick Children, Toronto, Ontario leighanne.bakel@sickkids.ca.
authors.forename: Leigh Anne
authors.initials: LA
authors.lastname: Bakel
authors.affiliation: Department of Pediatrics-Section of Hospital Medicine.
authors.forename: Karen
authors.initials: K
authors.lastname: Wilson
authors.affiliation: Department of Pediatrics-Section of Hospital Medicine.
authors.forename: Amy
authors.initials: A
authors.lastname: Tyler
authors.affiliation: Department of Pediatrics-Sections of Emergency Medicine Department of Pediatrics-Section of Clinical Informatics, and.
authors.forename: Eric
authors.initials: E
authors.lastname: Tham
authors.affiliation: Department of Pediatrics-Section of Hospital Medicine.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Reese
authors.affiliation: Department of Pediatrics-Sections of Emergency Medicine.
authors.forename: Joan
authors.initials: J
authors.lastname: Bothner
authors.affiliation: Department of Pediatrics-Section of Adolescent Medicine, University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado.
authors.forename: David W
authors.initials: DW
authors.lastname: Kaplan
mesh_terms: D057286:Electronic Health Records / Q000592:standards*; D006760:Hospitalization; D006776:Hospitals, Pediatric; D006801:Humans; D062527:Meaningful Use; D008501:Medical Records, Problem-Oriented / Q000706:statistics & numerical data*; D008505:Medical Staff, Hospital / Q000193:education*; D010351:Patient Discharge; D010372:Pediatrics / Q000592:standards; D011570:Psychiatry / Q000592:standards; D058996:Quality Improvement
keywords: care standardization; communication; electronic medical record; electronic problem list; information technology; problem list; problem lists; quality improvement