1040 — Development of an Electronic Health Record Quality Measurement Tool for the Care of Women with Abnormal Uterine Bleeding

Washington DL, VA Greater Los Angeles Healthcare System, HSR&D Center of Innovation; University of California, Los Angeles School of Medicine; Danz M, VA Greater Los Angeles Healthcare System, HSR&D Center of Innovation; RAND Santa Monica; Bell-Lewis L, VA Greater Los Angeles Healthcare System, HSR&D Center of Innovation; Cordasco KM, VA Greater Los Angeles Healthcare System, HSR&D Center of Innovation; University of California, Los Angeles School of Medicine;

Objectives:
Evidence-based, clinically-detailed quality indicators (QIs) are important for quality assessment and improvement, yet few electronic health record (EHR)-based QIs exist for women's health (WH) care. Abnormal uterine bleeding (AUB) is among the most common gynecologic complaint of reproductive-age women in ambulatory care settings, with up to 30% of women seeking medical care for AUB during their reproductive years. We sought to develop EHR-based QIs for AUB care.

Methods:
We first performed an extensive literature review to identify evidence-based guidelines and consensus recommendations for aspects of AUB care within the purview of primary care providers. For each potential QI, we specified a numerator, denominator, exclusions, relevant definitions, period of assessment, underlying evidence and data source. We then used a 3-step modified Delphi consensus technique based on the RAND/UCLA Appropriateness Method. First, nine experts independently rated the indicators on three metrics: consistency with established guidelines; importance to WH; and reliability of measurement from VA EHRs. Second, panelists discussed potential indicators by tele-conference, with internet-based sharing of presentation materials. Finally, panelists independently re-rated QIs using the same nine-point scales. Final QIs were selected if they had a median score > = 7 on all metrics, and statistically-defined consistency in ratings.

Results:
This process resulted in selection of 18 QIs for AUB care, spanning reproductive and post-menopausal life phases, profuse vaginal bleeding, and hormonal contraception/IUD use. Evaluation QIs highlighted the need to recognize pregnancy, need for emergency care, and elevated endometrial cancer risk. Management QIs focused on current profuse bleeding, follow-up of diagnostic studies, and indications for gynecologist referral. QIs were formulated into an EHR quality assessment tool based on AUB episodes-of-care.

Implications:
We developed a multi-dimensional set of QIs and formulated an EHR tool for assessment of primary care AUB evaluation and management.

Impacts:
This rigorously designed quality assessment tool should facilitate measuring and improving the quality of care for women with suspected AUB. Ongoing work is focused on developing educational programs that are concordant with these QIs, and assessing potential changes in quality outcomes associated with their implementation.