0368 Leveraging the Electronic Health Record to Facilitate Shared-Medical Decision Making in a Large Health System: Response to the PAP Recall

Abstract

Introduction The positive airway pressure (PAP) device manufacturer recall afflicting ~4 million users has posed a major challenge for the care of patients with sleep disordered breathing. We report on the Cleveland Clinic enterprise-wide response efforts and relevant predictors of medical decision-making surrounding this recall. Methods A taskforce developed a strategic response to the recall with the goal of distributing enterprise-wide communications; providing key guidance to providers and patients. For patients, a multi-pronged, tiered approach of MyChart messaging, phone and mailings instructing device registration and continuing use of PAP until discussed with the provider was implemented. For providers, an Epic smartphrase, embedded with a tracker, was developed as a resource including details of a decision-making algorithm while awaiting remediation. A team of mid-level providers was trained in the use of the algorithm; and the smartphrase was utilized for targeted virtual visits and communications. Presented is a retrospective cohort analysis of demographics and comorbid predictors between the group of patients advised to continue therapy, versus those advised to discontinue. Wilcoxon rank sum test or t-test was used for comparisons. Results 15,759 patients were contacted; message confirmed read/heard for 99.3%. Analysis of smartphrase use yielded 1135 instances (median,IQR): age:61.0 [51,70];48.5% female, 13.6% African American, body mass index(BMI) 33.5[29,38.9] kg/m2, apnea hypopnea index(AHI)=22.8[11.7,46.1] of whom n=770(67.8%) were advised to continued therapy. Predictors of provider guidance to continue versus temporarily hold PAP therapy respectively include: age:63[53,71] vs. 58[47,67] p<0.001, female:44% vs. 57%,p<0.001, BMI:33.9[29.5, 39.7] vs. 32.0[28.0,37.5],p<0.001, AHI:31.9[15.5, 58.0] vs.15.7[9.1,21.2],p<0.001 and the following comorbidities: hypertension:61.0% vs. 46.3%,p<0.001, coronary artery disease,11.3% vs. 3.6%,p<0.001,heart failure:2.6% vs. 0.6%,p<0.001, atrial fibrillation:9.5% vs. 2.5%,p<0.001 and chronic obstructive pulmonary disease:5.8% vs. 1.6%,p<0.001,but not diabetes. Conclusion We conclude that EHR tools can be used to coordinate device recall response efforts and guide both providers and patients. The use of a system smartphrase facilitated provider-patient shared medical decision-making to continue versus temporarily discontinue use of PAP therapy efficiently. Those advised to continue PAP therapy had higher burden of sleep apnea and cardiopulmonary comorbidity. Support (If Any)

Veterans Health Administration response to 2021 recall of Philips Respironics devices: A case study

“…One report examined whether recalled PAP devices could be modified to reduce risks (Rabec et al, 2022). In our domain of organizational case studies, we found two accounts, one from Mayo Clinic (Morgenthaler et al, 2022) and one from the Cleveland Clinic (Lance et al, 2022).…”