Abstracts

Rationale: Many people living with epilepsy (PWE) struggle to achieve seizure control due to factors related to their epilepsy and barriers to medication adherence, and are at greater risk of neuropsychiatric comorbidities such as depression and anxiety. The Epilepsy Learning Healthcare System (ELHS) seeks to utilize standardized inventories to capture pertinent patient-reported outcome measures (PROMs) related to important epilepsy quality metrics as a means toward improving patient care, but questionnaire completion is limited by low engagement among patients and providers. Here we implemented approaches to improve the PROMs questionnaire (PQ) completion rate (CR) in the outpatient setting of two tertiary Epilepsy centers, Massachusetts General Hospital (MGH) and Brigham and Women’s Hospital (BWH) using a quality improvement (QI) framework.

Methods: Weekly QI sessions with stakeholders (MGH, BWH, Epilepsy Foundation New England, ELHS) identified the goal of increasing the CR of institutional Epilepsy PROMS questionnaires (PQs) among patients seen by participating providers in two tertiary Epilepsy clinics (MGH and BWH). Patients were offered PQs through the Epic Patient Gateway prior to scheduled clinic encounters as part of an enterprise PROMS initiative unrelated to this study. Through Plan-Do-Study-Act (PDSA) cycles implemented by two staff members with access to the EHR, multiple interventions to increase PQ CR were iteratively assessed including telephone calls and SMS text message. Each week, patients with scheduled clinic visits who had not completed PQs were contacted approximately 2-3 days before their visit (telephone or SMS) to encourage PQ completion. CR was assessed weekly (post-clinic) and is defined as (1) number of patients with completed clinic encounters who completed PQs within the last 0-90 days, divided by (2) number of patients with completed clinic encounters.

Results: Work was approved under the MGB Workforce Quality Improvement IRB and took place from Jan 2022 to June 2022. Baseline PROMS questionnaire completion rate was estimated to be 42% prior to the study period (July 2021 through September 2021). In total, 546 patients from 7 providers over a total of 28 weeks are included in our results. Phone contact was noted to require considerable time from staff and was associated with median CR of 79.4% [IQR, 68.6%-83.8%] over 11 weeks at MGH and 71.4% [IQR, 62.9%-75.5%] over 10 weeks at BWH. Meanwhile, SMS required far less time and was associated with median CR of 79.2% [IQR, 73.2%-83.7%] over 7 weeks at MGH and 73.3% [IQR, 65.4%-89.4%] over 7 weeks at BWH, similar to phone calls.

Conclusions: Our preliminary results suggest that the CRs associated with simple SMS reminders are comparable to that of phone calls in achieving high PQ CRs ( >70%). Either phone calls or SMS reminders may improve CR vs. status quo. SMS may be a preferred method to improve PQ CR due to substantially lower resource utilization compared to phone calls. These findings may be actionable for many epilepsy centers endeavoring to improve PROMS completion among PWE -- a key step to enabling ELHSs.

Funding: None