title: Electronic Detection of Delayed Test Result Follow-Up in Patients with Hypothyroidism.
abstract: BACKGROUND
  Delays in following up abnormal test results are a common problem in outpatient settings. Surveillance systems that use trigger tools to identify delayed follow-up can help reduce missed opportunities in care.
  
  
  OBJECTIVE
  To develop and test an electronic health record (EHR)-based trigger algorithm to identify instances of delayed follow-up of abnormal thyroid-stimulating hormone (TSH) results in patients being treated for hypothyroidism.
  
  
  METHODS
  We developed an algorithm using structured EHR data to identify patients with hypothyroidism who had delayed follow-up (>60 days) after an abnormal TSH. We then retrospectively applied the algorithm to a large EHR data warehouse within the Department of Veterans Affairs (VA), on patient records from two large VA networks for the period from January 1, 2011, to December 31, 2011. Identified records were reviewed to confirm the presence of delays in follow-up.
  
  
  RESULTS
  During the study period, 645,555 patients were seen in the outpatient setting within the two networks. Of 293,554 patients with at least one TSH test result, the trigger identified 1250 patients on treatment for hypothyroidism with elevated TSH. Of these patients, 271 were flagged as potentially having delayed follow-up of their test result. Chart reviews confirmed delays in 163 of the 271 flagged patients (PPV = 60.1%).
  
  
  CONCLUSIONS
  An automated trigger algorithm applied to records in a large EHR data warehouse identified patients with hypothyroidism with potential delays in thyroid function test results follow-up. Future prospective application of the TSH trigger algorithm can be used by clinical teams as a surveillance and quality improvement technique to monitor and improve follow-up.
authors.affiliation: Houston VA Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, TX, USA. ameyer@bcm.edu.
authors.forename: Ashley N D
authors.initials: AND
authors.lastname: Meyer
authors.affiliation: Houston VA Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Daniel R
authors.initials: DR
authors.lastname: Murphy
authors.affiliation: Department of Family & Community Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Aymer
authors.initials: A
authors.lastname: Al-Mutairi
authors.affiliation: School of Biomedical Informatics and UT-Memorial Hermann Center for Healthcare Quality and Safety, The University of Texas Health Science Center at Houston, Houston, TX, USA.
authors.forename: Dean F
authors.initials: DF
authors.lastname: Sittig
authors.affiliation: Houston VA Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Wei
authors.affiliation: Houston VA Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Elise
authors.initials: E
authors.lastname: Russo
authors.affiliation: Houston VA Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
authors.forename: Hardeep
authors.initials: H
authors.lastname: Singh
mesh_terms: D000368:Aged; D057210:Delayed Diagnosis / Q000639:trends*; D003955:Diagnostic Tests, Routine / Q000379:methods; D057286:Electronic Health Records / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007037:Hypothyroidism / Q000097:blood* / Q000175:diagnosis* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D013960:Thyroid Function Tests / Q000379:methods / Q000639:trends*
keywords: electronic algorithms; hypothyroidism; patient safety; test result follow-up; thyroid-stimulating hormone (TSH); triggers