ABSTRACT
Introduction: Only 60% of atrial fibrillation (AF) patients with elevated stroke risk receive anticoagulation (AC). Closing this gap in AC use is particularly challenging in the face of the COVID19 pandemic. Electronic health record (EHR) alerts integrated into in-person and telehealth visits have the potential to close the gap. Hypothesis: A triad approach consisting of interventions at the practice provider at patient level could improve anticoagulation rates in patients with atrial fibrillation. Methods: In collaboration with the Heart Rhythm Society Quality Improvement Committee and UMass, University of Florida (UFL) Jacksonville launched a 2020 quality improvement (QI) intervention, including several Plan-Do-Study-Act (PDSA) cycles, centered around an outpatient, electronic health record (EHR) alert linked to an order set for AC meds, labs, and specialty referrals. The alert fired when cardiologists or primary care physicians saw AF patients in clinic with a CHA2DS2-VASc score of ≥2 who were not on AC. Due to COVID-19, several of the PDSA interventions required adjustments due to redeployment of information technology staff mobilized to generate COVID-19 reports, a pivot for clinicians and patients to telehealth visits, and a change in clinician and patient priorities from routine cardiovascular/preventive care to COVID-19 diagnosis and prevention. To assess intervention effectiveness, the change in AC use as a function of time was measured using a weighted least squares linear regression. Results: At time of launch, 2357 of 3555 eligible patients (56.3%) were on AC. At study end, six months later, the percentage of patients on AC increased by 1.5% to 57.8 %. Based on the population of untreated patients at UFL and the stroke rate for untreated patients (available from large registry data), and assuming absence of any competing/secular trend to explain the growth in AC use, we calculated that a 1.5% increase in the AC treatment percentage could result in the prevention of 1.5 strokes over one year. Conclusion: We demonstrated that an EHR alert can raise the rate of AC use in patients with AF after several rounds of PDSAs. In future efforts, we plan to reassess the AC percentage in our population and confirm the sustainability of our QI efforts as attention focuses back from the pandemic to routine cardiovascular/ preventive care.
ABSTRACT
Introduction: Historically, healthcare access has been an achilles heel of our healthcare system. Approximately 14.5% of US adults lack readily available access to healthcare and this has been worsened by the COVID-19 pandemic. There is limited data on use of telehealth in cardiology. We share our single-center experience on improving access to care via telehealth at the University of Florida cardiology fellows' clinic. Methods: Demographic and social variables were collected 6 months prior to and 6 months after initiation of telehealth. The effect of telehealth was determined via Chi-square and multiple logistic regression while controlling for demographic covariates. Results: We analyzed 3,316 cardiac clinic appointments over one year period. 1,569 and 1,747 scheduled clinic visits were prior to and after the start of telehealth, respectively. Patients that attended their scheduled follow-up had significantly greater odds of being in the post-telemedicine group while controlling for marital status and insurance type (OR 1.31, 95% CI 1.07-1.62). Patients who attended had higher odds of having city contract insurance (OR 3.51, 95% CI 1.79-6.87) compared to private insurance. City contract insurance is an indigenous care plan. There are also higher odds of being previously married (OR 1.34, 95% CI 1.05-1.70) or married/dating (OR 1.39, 95% CI 1.05-1.82) compared to being single for patients who attended their scheduled visits. Telehealth did not lead to increase in use of Mychart, the electronic patient portal (P-value 0.55). Conclusions: Telehealth improved patients' access to care in a cardiology fellows' clinic during the COVID-19 pandemic. Telehealth as a resource adjunct to traditional care in cardiology fellows' clinic should be further explore.