Impact of “Going Green” on quality of pelvic inflammatory disease care in adolescents: An institutional analysis

Background: Pelvic Inflammatory Disease (PID) is the most common gynecologic cause of yearly emergency department visits for women of reproductive age in the United States. Health care facilities have been encouraged to adopt electronic health records (EHR) and integrated electronic provider order entry (POE) systems to improve care. There is a need to evaluate the effect of the transition to these systems of paper-based quality assurance protocols for PID treatment among adolescent girls. Purpose: To evaluate effect of the transition to POE on the paper-based quality of care provided for adolescents being treated for PID in pediatric ambulatory care settings within a large academic medical center after transition to an integrated EHR/POE system. Methods: Retrospective medical record review using 71 of medical records from a 2004 quality assurance review were compared with 44 records from 2009. During time interval use of an effective paper-based PID quality assurance intervention was discontinued and an integrated POE system implemented institutionally. Charts were identified by ICD-9 codes and evaluated using a standardized data extraction form to determine provider adherence to the Centers for Disease Control and Prevention (CDC) STD Guidelines for diagnosis and treatment of PID. Data were evaluated using chi-square and logistic regression analysis. Results: The majority of participants was African American and insured through public health insurance. The mean age was 17.2 ± 1.5 years. At baseline, 83% (N=71) had minimum diagnostic criteria for PID documented compared with 95% (N=44) at follow-up. At follow-up, however, patients were less likely to receive a standardized medication regimen compared with baseline [OR: (0.419; 95% CI: .045 – 3.914, 95% CI]. Conclusions: Use of integrated POE systems may result in better documentation but without interactive aid to clinical decision-making; care may not meet national standards. Additional strategies to ensure provider adherence to national guidelines are warranted.