community-based collaboration in the epilepsy learning healthcare system to improve completion of patient-reported outcomes

Abstracts

Community-based Collaboration in the Epilepsy Learning Healthcare System to Improve Completion of Patient-reported Outcomes

Abstract number : 1.144
Submission category : 13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year : 2024
Submission ID : 261
Source : www.aesnet.org
Presentation date : 12/7/2024 12:00:00 AM
Published date :

Authors :
Presenting Author: Aya ElHassan, BS – Massachusetts General Hospital

Maria Donahue, MD – Massachusetts General Hospital
Anjana Rayapureddy, BS – MGB
Julianne Brooks, M.P.H. – Massachusetts General Hospital
Christopher McGraw, MD, PhD – MGB
Shelby Phillips, BS – MGB
Brandy Fureman, PhD – Epilepsy Foundation
Saim Muhammad, MD – MGB
Poojith Nuthalapati, MD – Yale School of Medicine, Comprehensive Epilepsy Center, Department of Neurology
Levi Barros, MD – MGB
Saiyid Ahmad Ali Naqvi, MBBS – Massachusetts General Hospital
Sydney Cash, MD, PhD – Massachusetts General Hospital and Harvard Medical School
Lidia V.M.D. Moura, M.D., PhD, MPH – Massachusetts General Hospital
Sahar Zafar, M.D., MSc – Massachusetts General Hospital

Rationale: Epilepsy affects about 3.4 million people in the United States. People living with epilepsy (PWE) struggle with medication adherence, frequent seizures, mental health comorbidities, and low quality of life. To identify common issues experienced by PWEs and develop future interventions, we aimed to increase the response rate to Patient Reported Outcome (PRO) measures. We used Quality Improvement (QI) in an Epilepsy Learning Healthcare System (ELHS) affiliated epilepsy clinic while leveraging our partnership with a community health organization, the Epilepsy Foundation of New England (EFNE).

Methods: In January 2019, we implemented ELHS Case Report Forms (CRFs) in our clinical workflow through the Patient Reported Outcomes (PROMs) Program at the MGH Epilepsy Clinic. PROMs programmed ELHS CRFs in the patient portal and assigned PWEs their PROMs CRFs at every outpatient visit. From January 2023 to May 2024, through EFNE’s partnership, we developed a Key Driver Diagram (figure 1) to increase patient response rates for all PWE seen at the Epilepsy Clinic by ELHS-affiliated providers. Using Plan-Do-Study-Act (PDSA) cycles we tested an intervention in which an EFNE community health worker (CHW) called PWEs before their clinic visit as a reminder to complete their PROMs CRFs via the patient portal. We measured PDSA cycles weekly through the numerator (PWEs who completed their PROMs) and denominator (total PWEs seen in the Epilepsy Clinic that week by an ELHS provider who had not yet completed their PROMs), and we tracked progress with run charts. During weekly huddles, we would determine if an intervention had been successful or needed to be modified during the next cycle.

Results: 1067 unique PWEs were seen in the MGH Epilepsy Clinic from January 2023 to May 2024. PWEs seen at the Epilepsy Clinic had a total of 1914 visits. Overall, 778 (778/1067; 73%) unique PWEs completed PROMs via the patient portal. Specifically for the intervention (EFNE CHWs calling PWEs), 951 (951/1067; 89%) PWEs were called; 532 (532/951; 56%) PWEs answered, and 419 (419/951; 44%) did not. Of the PWEs who answered the call, EFNE CHW connected with 332 (332/532; 62%) PWEs who completed their PROMs. 116 (116/1067; 11%) PWEs were not called because they had already completed their PROMs. Our baseline PROMs completion rate started at 36% in 2021. On a week-by-week trend, the overall patient response rate was 80% on average (figure 2 shows our p-chart).

Conclusions: After testing various interventions through PDSAs and leveraging support from EFNE CHWs, we sustained a patient response rate of 80% or above, proving a successful and effective intervention, leading to implementing this intervention in our Epilepsy Clinic.

Funding: None

Health Services (Delivery of Care, Access to Care, Health Care Models)