An electronic medical record-based intervention to improve quality of care for gastro-esophageal reflux disease (GERD) and atypical presentations of GERD

Marty S. Player, James M. Gill, Arch G. Mainous, Charles J. Everett, Richelle J. Koopman, James J. Diamond, Michael Lieberman, Ying Xia Chen

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Background Gastro-esophageal reflux disease (GERD)is common in primary care but is often underdiagnosed and untreated. GERD can also present with Iatypical symptoms like chronic cough and asthma, and physicians may be unaware of this presentation.We aimed to implement and evaluate an intervention to improve diagnosis and treatment for GERD and atypical GERD in primary care.Method This was a randomised controlled trial in .primary care office practice using a national network of US practices (the Medical Quality Improvement Consortium - MQIC) that share the same electronic medical record (EMR).Thirteen offices with 53 proividers were randomised to the intervention of EMR-based prompts and education, and 14 offices with 66 providers were randomised to the control group totalling over 67 000 patients and examining outcomes of GERD diagnosis and appropriate treatment.Results Among patients who did not have GERD at baseline, new diagnoses of GERD increased significantly in the intervention group (3.1%) versus the control group (2.3%) (P>0.01). This remained significant after controlling for clustering with an odds of diagnosis of 1.33 (95% CI 1.13-1.56) for the intervention group.For patients with atypical symptoms, those in the intervention group had both higher odds of being diagnosed with GERD (OR 2.02,95% CI 1.41-2.88) and of being treated for GERD (OR 1.40, 95% CI 1.08-1.83) than those in the control group.Conclusions GERD diagnosis and treatment in primary care, particularly among patients with atypical symptoms, can be improved through the use of an EMR-based tool incorporating decision support and education.However, significant room for improvement exists in use of appropriate treatment.

Original languageEnglish (US)
Pages (from-to)223-229
Number of pages7
JournalQuality in Primary Care
Volume18
Issue number4
StatePublished - 2010
Externally publishedYes

Fingerprint

Esophageal Diseases
Electronic Health Records
Quality of Health Care
Gastroesophageal Reflux
Primary Health Care
Control Groups
Education
Therapeutics
Quality Improvement
Cough
Cluster Analysis
Asthma
Randomized Controlled Trials

Keywords

  • Atypical symptoms
  • Electronic medical record
  • Gastro-esophageal reflux disease

ASJC Scopus subject areas

  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Player, M. S., Gill, J. M., Mainous, A. G., Everett, C. J., Koopman, R. J., Diamond, J. J., ... Chen, Y. X. (2010). An electronic medical record-based intervention to improve quality of care for gastro-esophageal reflux disease (GERD) and atypical presentations of GERD. Quality in Primary Care, 18(4), 223-229.

An electronic medical record-based intervention to improve quality of care for gastro-esophageal reflux disease (GERD) and atypical presentations of GERD. / Player, Marty S.; Gill, James M.; Mainous, Arch G.; Everett, Charles J.; Koopman, Richelle J.; Diamond, James J.; Lieberman, Michael; Chen, Ying Xia.

In: Quality in Primary Care, Vol. 18, No. 4, 2010, p. 223-229.

Research output: Contribution to journalArticle

Player, MS, Gill, JM, Mainous, AG, Everett, CJ, Koopman, RJ, Diamond, JJ, Lieberman, M & Chen, YX 2010, 'An electronic medical record-based intervention to improve quality of care for gastro-esophageal reflux disease (GERD) and atypical presentations of GERD', Quality in Primary Care, vol. 18, no. 4, pp. 223-229.
Player, Marty S. ; Gill, James M. ; Mainous, Arch G. ; Everett, Charles J. ; Koopman, Richelle J. ; Diamond, James J. ; Lieberman, Michael ; Chen, Ying Xia. / An electronic medical record-based intervention to improve quality of care for gastro-esophageal reflux disease (GERD) and atypical presentations of GERD. In: Quality in Primary Care. 2010 ; Vol. 18, No. 4. pp. 223-229.
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abstract = "Background Gastro-esophageal reflux disease (GERD)is common in primary care but is often underdiagnosed and untreated. GERD can also present with Iatypical symptoms like chronic cough and asthma, and physicians may be unaware of this presentation.We aimed to implement and evaluate an intervention to improve diagnosis and treatment for GERD and atypical GERD in primary care.Method This was a randomised controlled trial in .primary care office practice using a national network of US practices (the Medical Quality Improvement Consortium - MQIC) that share the same electronic medical record (EMR).Thirteen offices with 53 proividers were randomised to the intervention of EMR-based prompts and education, and 14 offices with 66 providers were randomised to the control group totalling over 67 000 patients and examining outcomes of GERD diagnosis and appropriate treatment.Results Among patients who did not have GERD at baseline, new diagnoses of GERD increased significantly in the intervention group (3.1{\%}) versus the control group (2.3{\%}) (P>0.01). This remained significant after controlling for clustering with an odds of diagnosis of 1.33 (95{\%} CI 1.13-1.56) for the intervention group.For patients with atypical symptoms, those in the intervention group had both higher odds of being diagnosed with GERD (OR 2.02,95{\%} CI 1.41-2.88) and of being treated for GERD (OR 1.40, 95{\%} CI 1.08-1.83) than those in the control group.Conclusions GERD diagnosis and treatment in primary care, particularly among patients with atypical symptoms, can be improved through the use of an EMR-based tool incorporating decision support and education.However, significant room for improvement exists in use of appropriate treatment.",
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