(182) Electronic health record smart-phrase intervention to improve rates of low-dose aspirin prescription for preeclampsia prevention

While low-dose aspirin (LDA) is recommended for preeclampsia prevention in at-risk patients, studies show suboptimal screening and prescription in routine obstetric care. The goal of this quality improvement initiative was to create, implement and test an electronic health record (EHR) smart-phrase to increase LDA prescription rates.

Study Design:

After a retrospective analysis in 2021 revealed low baseline rates of LDA prescription for eligible patients within our academic hospital system (Table), an LDA eligibility screening smart-phrase was created and launched for use in First OB note templates through a departmental quality initiative from January 2023-May 2024 (Figure). Low baseline LDA prescription rates were shared at Hospital-Wide OB, OBGYN Generalist, and MFM Division meetings, with serial reminders to use the smart-phrase throughout the study period. Rates of smart-phrase utilization by obstetricians and LDA prescription for eligible patients were collected at three quality assessment cycles 3-, 9-, and 13-months post-intervention launch.

Results:

A total of 721 LDA eligible First OB notes were evaluated. Rates of LDA prescription for patients with at least one high-risk factor improved from 72% pre-intervention to 92% at 13-months post-intervention (Table). LDA prescription for patients with at least two moderate-risk factors and no high-risk factors improved from 21% pre-intervention to 61% at 13-months post-intervention. The use of the LDA eligibility screening smart-phrase during First OB visits increased during each quality assessment cycle from 42% to 53% and to 56% at 3-, 9-, and 13-months post-intervention, respectively. Of patients eligible for LDA, there was a statistically significant increase in prescription rates across the evaluation periods for patients whose provider used a smart-phrase (p=0.02, < 0.01, and 0.04 at 3-, 9-, and 13-months, respectively).

Conclusion:

Incorporating a risk-identifying smart-phrase into First OB EHR notes led to two synergistic improvements: increased identification of at-risk patients who are LDA eligible and increased rates of LDA prescription.