A Quality Improvement Pathway to Promote Health Equity by Increasing Compliance with Diagnostic Testing Following Telemedicine Visits in an Underserved Population

ABSTRACT

Objective: The primary aim of this quality improvement project focuses on improving compliance with diagnostic testing by 20% over a 6 month period. Background(s) Following the COVID-19 pandemic, there was a rapid upscaling in the use of telehealth. Telehealth is now being used to provide follow up visits in our pediatric gastroenterology fellows clinic, which is comprised of an underserved patient population. Limited access to care has been shown to disproportionately affect underserved populations. Prior to the use of telemedicine, diagnostic testing including blood work was completed or scheduled at the time of visit to promote compliance. With expansion of telemedicine, compliance with diagnostic testing in this patient population became a concern due to limited access and health literacy. Without timely completion of testing and results, there is potential for missed and delayed diagnoses, impeding the ability to treat effectively. Method(s) Prior to initiating intervention, preliminary data was collected including blood work, imaging, and stool studies completed at 2 weeks and by next visit. In PDSA 1, a standardized phrase was created to limit variability amongst providers. Our intervention involved sending Epic patient portal reminder messages within 24 hours of each appointment. In PDSA 2, a second reminder was added 2 weeks post visit. The quality improvement study began August of 2021 and is ongoing. Result(s) Background data was collected for compliance of diagnostic testing at 2 weeks for blood work (33%), imaging (17%), and stool samples (0%). We also collected data on diagnostic testing completed by next visit for blood work (50%), imaging (50%), and stool samples (0%). Post intervention data was then collected over a 6 month period. Our data showed improvement to 50% compliance for completed blood work and 20% compliance for submitted stool samples 2 weeks out from visit. Data showed 100% compliance with blood work and 60% compliance with submitted stool studies prior to next visit, surpassing our goal of 20% improvement in compliance over a 4 month period. Our team also looked at completion of imaging orders, and scheduling of upper endoscopy and colonoscopy procedures prior to next visit. However the numbers were insufficient to draw any meaningful conclusions at this time. Conclusion(s) Our data supports the use of electronic medical record portal messaging systems as a valuable tool for promoting compliance with diagnostic testing in an underserved population following telemedicine visits. This is an opportunity to improve access to care and health equity. Data collection is ongoing for PDSA 2.