Abstract：
OBJECTIVE: To assess the quality of hydroxychloroquine (HCQ)-induced retinopathy screening at a Canadian tertiary center, we concentrate on risk factor documentation within the electronic health record, in accordance with the 2016 AAO guidelines.
METHODS: We performed a retrospective quality assessment study based on chart review of patients who underwent screening for HCQ-induced retinopathy at the Centre Hospitalier de l\'Université de Montréal (CHUM) from 2016 to 2019. We evaluated four key risk factors for HCQ-induced retinopathy: daily dose, duration of use, renal disease, and tamoxifen use, using a three-tier grading system (ideal, adequate, inadequate) for documentation assessment. Pareto and root cause analyses were conducted to identify potential improvement solutions.
RESULTS: Documentation quality varied in our study: daily dosage was 33% ideal, 31% appropriate, and 36% inappropriate. Duration of use documentation was 75% ideal, 2% adequate, and 24% inadequate. Renal disease documentation was only 6% ideal, with 62% adequate and 32% of charts lacking any past medical history. Among women\'s charts, tamoxifen use wasn\'t documented at all, with 65% adequately documenting medication lists. Pareto analysis indicated that improving renal disease and tamoxifen documentation could reduce 64% of non-ideal records, and enhancing daily dose documentation could decrease this by up to 90%.
CONCLUSIONS: Accurate documentation of key risk factors is critical for HCQ-induced retinopathy screening, impacting both exam initiation and frequency. Our study identifies potential improvements in the screening process at the hospital, referring physician, and ophthalmologist levels. Implementing integrated pathways could enhance patient experience and screening effectiveness.
METHODS: We performed a retrospective quality assessment study based on chart review of patients who underwent screening for HCQ-induced retinopathy at the Centre Hospitalier de l\'Université de Montréal (CHUM) from 2016 to 2019. We evaluated four key risk factors for HCQ-induced retinopathy: daily dose, duration of use, renal disease, and tamoxifen use, using a three-tier grading system (ideal, adequate, inadequate) for documentation assessment. Pareto and root cause analyses were conducted to identify potential improvement solutions.
RESULTS: Documentation quality varied in our study: daily dosage was 33% ideal, 31% appropriate, and 36% inappropriate. Duration of use documentation was 75% ideal, 2% adequate, and 24% inadequate. Renal disease documentation was only 6% ideal, with 62% adequate and 32% of charts lacking any past medical history. Among women\'s charts, tamoxifen use wasn\'t documented at all, with 65% adequately documenting medication lists. Pareto analysis indicated that improving renal disease and tamoxifen documentation could reduce 64% of non-ideal records, and enhancing daily dose documentation could decrease this by up to 90%.
CONCLUSIONS: Accurate documentation of key risk factors is critical for HCQ-induced retinopathy screening, impacting both exam initiation and frequency. Our study identifies potential improvements in the screening process at the hospital, referring physician, and ophthalmologist levels. Implementing integrated pathways could enhance patient experience and screening effectiveness.
摘要：
目的：评估加拿大三级中心羟氯喹（HCQ）诱导的视网膜病变筛查的质量，我们专注于电子健康记录中的风险因素文档，根据2016年AAO指南。
方法：我们根据2016年至2019年在蒙特利尔大学中心医院（CHUM）接受HCQ诱发视网膜病变筛查的患者的图表回顾，进行了一项回顾性质量评估研究。我们评估了HCQ诱导的视网膜病变的四个关键风险因素：日剂量，使用期限,肾脏疾病,和他莫昔芬的使用，使用三层分级系统(理想，adequate,不足)用于文件评估。进行了帕累托和根本原因分析，以确定潜在的改进解决方案。
结果：文档质量在我们的研究中有所不同：每日剂量为33％理想，31%合适,36%不合适。使用文档的持续时间是理想的75%，2%足够，24%不够。肾脏疾病记录只有6%是理想的，62%的人足够，32%的图表没有任何既往病史。在女性排行榜中，他莫昔芬的使用根本没有记录在案,65%的人充分记录药物清单。帕累托分析表明，改善肾脏疾病和他莫昔芬记录可以减少64％的非理想记录，和提高每日剂量文件可以减少高达90％。
结论：关键危险因素的准确记录对于HCQ诱导的视网膜病变筛查至关重要，影响考试开始和频率。我们的研究发现了医院筛查过程中的潜在改进，转诊医生，和眼科医生的水平。实施整合途径可以增强患者体验和筛查效果。
方法：我们根据2016年至2019年在蒙特利尔大学中心医院（CHUM）接受HCQ诱发视网膜病变筛查的患者的图表回顾，进行了一项回顾性质量评估研究。我们评估了HCQ诱导的视网膜病变的四个关键风险因素：日剂量，使用期限,肾脏疾病,和他莫昔芬的使用，使用三层分级系统(理想，adequate,不足)用于文件评估。进行了帕累托和根本原因分析，以确定潜在的改进解决方案。
结果：文档质量在我们的研究中有所不同：每日剂量为33％理想，31%合适,36%不合适。使用文档的持续时间是理想的75%，2%足够，24%不够。肾脏疾病记录只有6%是理想的，62%的人足够，32%的图表没有任何既往病史。在女性排行榜中，他莫昔芬的使用根本没有记录在案,65%的人充分记录药物清单。帕累托分析表明，改善肾脏疾病和他莫昔芬记录可以减少64％的非理想记录，和提高每日剂量文件可以减少高达90％。
结论：关键危险因素的准确记录对于HCQ诱导的视网膜病变筛查至关重要，影响考试开始和频率。我们的研究发现了医院筛查过程中的潜在改进，转诊医生，和眼科医生的水平。实施整合途径可以增强患者体验和筛查效果。
