title: Electronic Health Record Tools to Care for At-Risk Older Drivers: A Quality Improvement Project.
abstract: OBJECTIVE
  Evaluating driving safety of older adults is an important health topic, but primary care providers (PCP) face multiple barriers in addressing this issue. The study's objectives were to develop an electronic health record (EHR)-based Driving Clinical Support Tool, train PCPs to perform driving assessments utilizing the tool, and systematize documentation of assessment and management of driving safety issues via the tool.
  
  
  METHODS
  The intervention included development of an evidence-based Driving Clinical Support Tool within the EHR, followed by training of internal medicine providers in the tool's content and use. Pre- and postintervention provider surveys and chart review of driving-related patient visits were conducted. Surveys included self-report of preparedness and knowledge to evaluate at-risk older drivers and were analyzed using paired t-test. A chart review of driving-related office visits compared documentation pre- and postintervention including: completeness of appropriate focused history and exam, identification of deficits, patient education, and reporting to appropriate authorities when indicated.
  
  
  RESULTS
  Data from 86 providers were analyzed. Pre- and postintervention surveys showed significantly increased self-assessed preparedness (p < .001) and increased driving-related knowledge (p < .001). Postintervention charts showed improved documentation of correct cognitive testing, more referrals/consults, increased patient education about community resources, and appropriate regulatory reporting when deficits were identified.
  
  
  CONCLUSIONS
  Focused training and an EHR-based clinical support tool improved provider self-reported preparedness and knowledge of how to evaluate at-risk older drivers. The tool improved documentation of driving-related issues and led to improved access to interdisciplinary care coordination.
authors.affiliation: Division of Internal Medicine and Geriatrics, Oregon Health and Science University, Portland. caseyc@ohsu.edu.
authors.forename: Colleen M
authors.initials: CM
authors.lastname: Casey
authors.affiliation: Nurse Practitioner, Kaiser Permanente Northwest, Vancouver, Washington.
authors.forename: Katherine
authors.initials: K
authors.lastname: Salinas
authors.affiliation: Division of Internal Medicine and Geriatrics, Oregon Health and Science University, Portland.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Eckstrom
mesh_terms: D000328:Adult; D000368:Aged; D001334:Automobile Driving; D003661:Decision Support Techniques; D057286:Electronic Health Records / Q000458:organization & administration*; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000379:methods* / Q000458:organization & administration; D058996:Quality Improvement; D012107:Research Design; D018570:Risk Assessment
keywords: Driver assessment; Driving; Electronic health record; Geriatric training