Harnessing the Electronic Health Record to Identify and Enroll People with Epilepsy into a Self-management Program
Abstract number :
2.062
Submission category :
13. Health Services (Delivery of Care, Access to Care, Health Care Models)
Year :
2024
Submission ID :
66
Source :
www.aesnet.org
Presentation date :
12/8/2024 12:00:00 AM
Published date :
Authors :
Presenting Author: Gena Ghearing, MD – University of Iowa
Michael Privitera, MD – University of Cincinnati
Maegan Tyrrell, BA – University of Iowa
Dana LoTempio, DNP – University of Iowa
Lucy Mendoza, CCRP – University of Cincinnati
Martha Sajatovic, MD – Case Western Reserve University School of Medicine
Richard Barigye, BSc – Case Western Reserve University School of Medicine
Clara Adeniyi, BS – Case Western Reserve University School of Medicine
Carrie Rogers, BS – Case Western Reserve University, School of Medicine
David Ficker, MD – University of Cincinnati
Rationale: Epilepsy self-management (ESM) can help people with epilepsy (PWE) follow medication schedules, reduce stress or depressive symptoms, and help better communicate with care providers. SMART is an 8-week, online, evidence-based ESM program developed by this team as part of the Centers for Disease Control and Prevention (CDC) funded MEW Network. SMART and other ESMs for PWE are effective but underutilized. The aim of this project was to scale up SMART in clinical settings via the electronic health record (EHR) to identify and enroll PWE into SMART.
Methods: This is a 5-year, ongoing SMART implementation effort. Two Level 4 Epilepsy Centers (Iowa and Cincinnati) use the Epic EHR and follow a total of 9326 PWE. The EHR was programmed to identify PWE with any of the following characteristics detected through pre-visit screening: a recent seizure; self-reported barriers to medication adherence; depression (using either PHQ-8 or NDDI-E); anxiety (using GAD-7); age 18-25; or living in rural regions. Excluded PWE had substantial cognitive impairment or no internet or phone access. At outpatient visits, Epic was set to generate a Best Practice Advisory (BPA) to clinicians. The clinician clicked the alert signaling either the PWE declined, was not a candidate, or forwarded a referral if the PWE was interested. Referral messages were received by site program coordinators who then followed up with the PWE and facilitated SMART scheduling. SMART groups are led by nurse-educators and peer-educators who have all been trained to deliver SMART following a detailed curriculum. Training occurred in 2 half-day training sessions and has ongoing training support. The program will enroll 80 PWE in SMART year 1, implement the EHR BPA at additional Epilepsy Centers in years 3-5, and enroll a cumulative total of approximately 560 PWE. A stakeholder advisory board (SAB) of PWE and health care providers from the regions of the Epilepsy Centers meets annually to support implementation. Screening data for depression, anxiety, seizure occurrence, age and rurality were captured either online prior to the visit, through a tablet in the waiting room, or on paper forms in the exam room. Barriers to medication adherence was collected at the Cincinnati site initially.
Results: BPA were programmed and set to fire at both sites in mid-April of 2024. Within the first 30 days of BPA activation 680 alerts were sent to clinicians, and 137 PWE were referred to the program coordinators for entry into subsequent SMART groups. 11 Nurse and Peer Educators received training. A 12 member SAB met in March 2024. Updated results will be presented.
Conclusions: BPAs to clinicians within an EHR system are a potentially effective and practical method to identify and refer PWE to evidence-based epilepsy self-management programs. Preliminary data on BPA roll-out in 2 epilepsy centers suggest the approach is feasible and amenable to scale-up.
Funding: CDC 7544 (NU58DP007544)
Health Services (Delivery of Care, Access to Care, Health Care Models)