Use of Electronic Health Record Best Practice Alerts to Improve Adherence to American Urological Association Vesicoureteral Reflux Guidelines

Abstract

Purpose: To evaluate the effect of a guidelines-based best practice alerts (BPA) in the electronic health record (EHR) on adherence to American Urological Association (AUA) vesicoureteral reflux (VUR) guidelines.Methods: Retrospective cohort study of patients aged 0-17 years old with primary VUR with an initial urology clinic visit the year before or year after BPA implementation. Primary outcomes include obtaining vital signs, urinalysis, and ultrasound at initial and one-year follow-up visit. Results: We identified 123 patients with initial visits during the study period, 58 of whom returned for one-year follow-up visits. Patients seen post-BPA were more likely to have height measured at initial visit than those seen pre-BPA (47.3% vs 11.8%, p<0.001). The majority of patients were screened with weight (98.3%) and ultrasound (87.9%) at one-year follow-up both before and after BPA implementation. Neither blood pressure measurements (59.1% vs 55.6%, p>0.5) nor urinalysis orders (23.8% vs 19.4%, p>0.05) significantly increased post-BPA. Conclusion: The use of an EHR-based BPA increased the likelihood of obtaining height measurements by clinic intake staff but did not significantly affect provider adherence to other practice guideline recommendations. Our findings suggest that BPA implementation alone is not sufficient to impact provider uptake of VUR guideline recommendations.