Nastassja Williams

Scholarly Project Advisor: Jessica Sullivan DNP, APRN-FPA, FNP-BC, CNE.

Affiliated Organization where the project occurred: Northwestern Medicine Digestive Health Center, Chicago, IL.

Any Funding you received for the Project: No funding was received for this project.

External Dissemination of the Project (Podium or Poster): Poster Display at the Gastroenterology and Hepatology Advance Practice Provider (GHAPP) Conference Sept 7th-9th.

Publication: Will be submitting to The Journal for Nurse Practitioners (JNP).

Introduction/Problem

Helicobacter pylori (H. pylori) accounts for 15% of the total gastric cancer burden globally, with up to 89% of all gastric cancers attributed to H. pylori infection (Shah et al., 2021). Due to the rise in clarithromycin resistance, the current 2017 American College of Gastroenterology (ACG) guidelines recommend avoiding clarithromycin in areas where the clarithromycin resistance rate is greater than 15% and using bismuth quadruple therapy as first-line treatment for H. pylori (Chey et al., 2017). The guidelines also recommend testing to prove eradication after treatment is completed (Chey et al., 2017). In 2020 the department of gastroenterology of a large academic center implemented a clinical smart set. The term "Smart Set" is the Epic health information technology system branded term for a combined documentation, decision and inquiry-support tool that can group multiple pre-filtered functions for a more efficient and error-free charting workflow. At that time provider education was not provided which resulted in low utilization due to lack of awareness.

The purpose of this quality improvement (QI) project was to evaluate if reimplementation of an evidence-based electronic health record smart set increases negative H. pylori eradication results, improves provider adherence to treatment guidelines, and increases provider ordering and patient completion of eradication testing in adults at an ambulatory academic gastroenterology practice over three months.

Methods

The smart set reimplementation QI project involved a 15-minute PowerPoint educational session, and reminder fliers were placed in outpatient work rooms. Retrospective and prospective analyses were performed. Logistic regression and multinomial regression were used to test the association of the intervention to variables of interest.

Findings

Advanced practice providers (APPs) had a higher smart set utilization in the pre-intervention and post- intervention groups when compared to physicians. One hundred percent of eradication tests in the post-intervention group were negative compared to 90.9% in the pre-intervention group. Smart set utilization increased post-intervention when compared to pre-intervention (38.6% vs 43.9%). There was an increase in treatment with clarithromycin triple therapy post intervention when compared to preintervention. Provider ordering of eradication testing and patient completion of eradication testing decreased post intervention when compared to preintervention. None of the findings were statistically significant.

Practice Implications

SmartSet reimplementation clinically appears to be an effective tool to increase negative H. pylori eradication results and increase smart set utilization. This QI project exemplifies translating evidence and integrating technology into clinical practice. While it did not improve provider adherence to treatment guidelines or increase provider ordering or patient completion of eradication testing, it does demonstrate the importance of ongoing continuing education regarding smart sets and inclusion of the information for current and newly hired providers.