Quality Improvement and Practice-Based Research in Peripheral Neuropathy Using the Electronic Medical Record (P1.446)

Objective: To develop a structured clinical documentation support (SCDS) toolkit within the electronic medical record (EMR) that navigates care, writes notes, and captures data at office visits; To share the toolkit with neuromuscular specialists using the Epic EMR platform, as part of a Neurology Practice-Based Research Network (NPBRN). Background: We developed a seven-stage process for quality improvement and practice-based research in Neurology using the EMR: 1) SCDS toolkits (custom navigators, electronic forms, smart data elements); 2) enrollment reports; 3) data quality reports; 4) descriptive cohort reports; 5) quality improvement dashboards; 6) clinical decision support; 7) sharing of toolkits and data (NPBRN). Design/Methods We met every two weeks for three months to develop content: define the cohort, select outcome measures, and delineate factors known to modify disease progression. We assigned tasks to the care team and mapped data elements to the progress note. We then met every two weeks for three more months with programmer analysts to build and test the SCDS toolkit. Auto scored and interpreted tests included the Center for Epidemiological Studies-Depression (CES-D) scale, Fatigue Severity Scale (FSS), Survey of Autonomic Symptoms (SAS), Insomnia Severity Index (ISI), modified Rankin scale (mRankin), timed 25 foot walk (T25-W) and newly created North Shore Neuropathy Impairment Score (NS-NIS). Results: Our toolkit captures 745 fields of data per office visit. We have used the toolkits 685 times to assess patients at initial visits for possible neuropathy, finding distal symmetrical polyneuropathy in 334 of those patients. We present screenshots of our SCDS toolkit and descriptive data, pairwise correlations principal component analyses of score test measures at initial visit from 334 patients in our neuropathy cohort. Conclusions: The EMR can be effectively structured to standardize peripheral neuropathy office visits, capture data, and support multicenter quality improvement and practice-based research initiatives. Study Supported by: Funding is provided by the Agency for Healthcare Research and Quality grant 5R01HS024057-03 “Quality Improvement and Practice-Based Research in Neurology Using the EMR.” Disclosure: Dr. Kincaid has nothing to disclose. Dr. Barboi has nothing to disclose. Dr. Randall has nothing to disclose. Dr. Garduno has nothing to disclose. Dr. Szela has nothing to disclose. Dr. Tideman has nothing to disclose. Dr. Hillman has nothing to disclose. Dr. Macapinlac has nothing to disclose. Dr. Frigerio has nothing to disclose. Dr. Simon has nothing to disclose. Dr. Maraganore has nothing to disclose.