Electronic Health Record-Driven Approaches in Primary Care to Strengthen Hypertension Management Among Racial and Ethnic Minoritized Groups in the United States: Systematic Review.

BACKGROUND: Managing hypertension in racial and ethnic minoritized groups (eg, African American/Black patients) in primary care is highly relevant. However, evidence on whether or how electronic health record (EHR)-driven approaches in primary care can help improve hypertension management for patients of racial and ethnic minoritized groups in the United States remains scarce. OBJECTIVE: This review aims to examine the role of the EHR in supporting interventions in primary care to strengthen the hypertension management of racial and ethnic minoritized groups in the United States. METHODS: A search strategy based on the PICO (Population, Intervention, Comparison, and Outcome) guidelines was utilized to query and identify peer-reviewed articles on the Web of Science and PubMed databases. The search strategy was based on terms related to racial and ethnic minoritized groups, hypertension, primary care, and EHR-driven interventions. Articles were excluded if the focus was not hypertension management in racial and ethnic minoritized groups or if there was no mention of health record data utilization. RESULTS: A total of 29 articles were included in this review. Regarding populations, Black/African American patients represented the largest population (26/29, 90%) followed by Hispanic/Latino (18/29, 62%), Asian American (7/29, 24%), and American Indian/Alaskan Native (2/29, 7%) patients. No study included patients who identified as Native Hawaiian/Pacific Islander. The EHR was used to identify patients (25/29, 86%), drive the intervention (21/29, 72%), and monitor results and outcomes (7/29, 59%). Most often, EHR-driven approaches were used for health coaching interventions, disease management programs, clinical decision support (CDS) systems, and best practice alerts (BPAs). Regarding outcomes, out of 8 EHR-driven health coaching interventions, only 3 (38%) reported significant results. In contrast, all the included studies related to CDS and BPA applications reported some significant results with respect to improving hypertension management. CONCLUSIONS: This review identified several use cases for the integration of the EHR in supporting primary care interventions to strengthen hypertension management in racial and ethnic minoritized patients in the United States. Some clinical-based interventions implementing CDS and BPA applications showed promising results. However, more research is needed on community-based interventions, particularly those focusing on patients who are Asian American, American Indian/Alaskan Native, and Native Hawaiian/Pacific Islander. The developed taxonomy comprising "identifying patients," "driving intervention," and "monitoring results" to classify EHR-driven approaches can be a helpful tool to facilitate this.

A Longitudinal Curriculum for Quality Improvement, Leadership Experience, and Scholarship in a Family Medicine Residency Program.

BACKGROUND AND OBJECTIVES: The Accreditation Council for Graduate Medical Education (ACGME) requires all residents be trained in quality improvement (QI), and that they produce scholarly projects. While not an ACGME requirement, residents need leadership skills to apply QI knowledge. We developed the Skills-based Experiential Embedded Quality Improvement (SEE-QI) curriculum to integrate training in QI, leadership, and scholarship. METHODS: The University of Utah Family Medicine Residency Program began using the novel curriculum in 2012. The aim of the curriculum is to tie didactic teaching in quality improvement, leadership, and scholarship with skills application on multidisciplinary QI teams. Coaching for resident leaders is provided by faculty. Third-year resident leaders prepare academic presentations. Results of the ACGME Practice-Based Learning and Improvement (PBLI) 3 scores and number of scholarship presentations are described as a measure of efficacy. RESULTS: Two cohorts of residents completed the curriculum and all competency assessments. The average initial and final competency scores for competency PBLI-3 showed improvement and the average final competency for each cohort was above the proficient level. The residency requirements for QI scholarship did not change with introduction of the curriculum, but the amount of optional curricular QI scholarship and independent QI scholarship increased. CONCLUSIONS: The SEE-QI curriculum resulted in a high level of resident QI competency, opportunity for leadership training, and an increase in scholarship. We studied the results of this curriculum at one institution. Efforts to tie QI, leadership, and scholarship training should be evaluated at other programs.

Use of a Hepatitis C Screening Order Set to Improve Screening Rates and Measure Intervention Effectiveness.

INTRODUCTION: Hepatitis C virus (HCV) infection leads to significant morbidity and mortality. Rates of HCV infection are greatest in patients born from 1945 to 1965, so the Centers for Disease Control recommends a one-time screening in this cohort. Previous interventions utilizing the electronic medical record (EMR) capabilities at two University of Utah Family Medicine clinics have increased screening rates significantly, but further improvement is possible. METHODS: A family medicine resident-led continuous quality improvement (CQI) team used the Model for Improvement methods popularized by the Institute for Healthcare Improvement to create a team-based intervention with the goal of improving HCV screening in a family medicine faculty and resident clinic. An order set was created and a protocol developed that allowed medical assistants or clinic phlebotomists to order the appropriate HCV screening lab if this had not yet been done by the primary care provider. Data were extracted from the EMR that showed changes in total and monthly screening rates as well as the frequency of order set use. RESULTS: Monthly screening rates at the Madsen Family Medicine Clinic (Salt Lake City, UT) increased from approximately 40% to greater than 50% in the 5-month intervention period. The order set was used 19 times during this period which accounted for 18.8% of new screens. CONCLUSIONS: Creating an order set that allows medical assistants to order the HCV screening lab increased HCV screening rates in our clinic. Because order set utilization data can be extracted from the EMR, this intervention provided a process measure that can differentiate the effect of this intervention from the effects of other interventions previously undertaken in the clinic.

Development and Validation of the Foundational Healthcare Leadership Self-assessment.

BACKGROUND AND OBJECTIVES: We sought to develop and validate a self-assessment of foundational leadership skills for early-career physicians. METHODS: We developed a leadership self-assessment from a compilation of materials on health care leadership skills. A sequential exploratory study was conducted using qualitative and quantitative analysis for face, content, and construct validity of the self-assessment. First, two focus groups were conducted with leaders in medicine and family medicine residents, to refine the pilot self-assessment. The self-assessment pilot was then tested with family medicine residents across the country, and the results were quantitatively evaluated with principal component analysis. This data was used to reduce and group the statements into leadership domains for the final self-assessment. RESULTS: Twenty-two invited family medicine residency programs agreed to distribute the survey. A total of 163 family medicine residents completed the survey, representing 16 to 20 residency programs from 12 states (response rate 28.9% to 34.8%). Analysis showed important differences by residency year, with more advanced residents scoring higher. The analysis reduced the number of items from 33 on the pilot assessment to 21 on the final assessment, which the authors titled the Foundational Healthcare Leadership Self-assessment (FHLS). The 21 items were grouped into five leadership domains: accountability, collaboration, communication, team management, and self-management. CONCLUSIONS: The FHLS is a validated 21-item self-assessment of foundational leadership skills for early career physicians. It takes less than 5 minutes to complete, and quantifies skill within five domains of foundational leadership. The FHLS is a first step in developing educational and evaluative assessments for training medical residents as clinician leaders.