title: Using EMR to improve compliance with clinical practice guidelines for management of stable COPD.
abstract: BACKGROUND
  Clinical practice guidelines are underutilized in the outpatient management of chronic obstructive pulmonary disease (COPD). We hypothesize that a structured approach using the electronic medical record (EMR) will improve compliance with clinical practice guidelines for the evaluation and management of patients with stable COPD.
  
  
  METHODS
  Clinical records were evaluated in a pre- and post-intervention analysis of patients with COPD seen in our pulmonary clinics at a single tertiary care academic setting. Patient charts were retrospectively screened for the diagnosis of COPD and individually assessed for a diagnosis of COPD by spirometry. We then developed and implemented a COPD Flowsheet based on clinical practice guidelines into each outpatient clinic encounter for COPD with repeat chart review of clinic patients. Improvement in the pre- to post-intervention quality metrics were compared using t-test and Chi squared as indicated. A p-value of <0.05 was considered significant.
  
  
  RESULTS
  A total of 200 patients were screened in the pre-intervention period and 347 in the post-intervention period. Of these, 144 (72%) and 267 (77%) met criteria for COPD based on FEV(1)/FVC < 0.70, respectively. There was a significant increase in the use of severity assessment by BODE index (13.2% vs 32.2%, p-value < 0.001), inhaler technique teaching (35.4% vs 65.2%, p-value < 0.001), osteoporosis screening (20.8% vs 44.9%, p-value < 0.001) and influenza vaccination (74.3% vs 83.5%, p-value = 0.03) in post intervention period.
  
  
  CONCLUSIONS
  Implementation of a standardized COPD Flowsheet developed from clinical practice guidelines improves advanced assessment of patients with COPD and other quality of care measures.
authors.affiliation: Department of Internal Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, United States; Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, United States. Electronic address: jmterasaki@gmail.com.
authors.forename: Jordan
authors.initials: J
authors.lastname: Terasaki
authors.affiliation: Department of Internal Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, United States; Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, United States.
authors.forename: Gurinder
authors.initials: G
authors.lastname: Singh
authors.affiliation: Department of Internal Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, United States; Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, United States.
authors.forename: Wei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Internal Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, United States; Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, United States.
authors.forename: Penny
authors.initials: P
authors.lastname: Wagner
authors.affiliation: Department of Internal Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, United States; Division of Pulmonary, Critical Care and Sleep Medicine, University of Texas Medical Branch, 301 University Blvd, Galveston, TX 77555, United States.
authors.forename: Gulshan
authors.initials: G
authors.lastname: Sharma
mesh_terms: D000368:Aged; D057286:Electronic Health Records; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010044:Outpatient Clinics, Hospital / Q000592:standards; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013147:Spirometry; D013781:Texas; D014797:Vital Capacity / Q000502:physiology
keywords: COPD clinical practice guidelines; COPD management; EMR electronic medical records; Outpatient COPD