Improving AAA Screening Rates in a US-Mexico Border Academic Clinic

From the 2022 HVPA National Conference

Amit Sureen D.O. (Texas Tech University Health Sciences Center El Paso), Helen Kreit D.O., Sara Alhariri M.D., Hien Pham D.O., Chelsey Bravenec M.D., Kingsley Dah M.D., Inayatullah Wahdatyar D.O., Ilmaben Vahora M.D., Sandesh Yohannan M.D. , Sahithi Nadella M.D. , Jose Rayas M.D., Claire Gardner M.D.

Background

Abdominal aortic aneurysm (AAA) is a disease that can be screened by an abdominal ultrasound in men who have ever smoked from the ages of 65-75 per the USPSTF Grade B recommendations. In other countries, the prevalence of AAA has declined over the past 2 decades secondary to increased screening. However, the current prevalence of AAA in the United States is unclear at this time due to low screening. Majority of AAAs are asymptomatic with patients until they rupture, and the risk for death due to rupture can be as high as 81%.

Objective

The purpose of this study is to examine whether patient and resident education would increase screening rates in an academic Internal Medicine clinic along the US-Mexico border.

Methods

IRB approval was obtained to use inpatient and outpatient electronic medical record data from the University Medical Center of El Paso, Texas and the respective Texas Tech Internal Medicine Clinic from January 2019 to April 2022. An electronic medical record (EMR) report identified 345 eligible patients per the USPSTF Grade B recommendations. Each patient’s chart was reviewed to evaluate their screening status, and their respective medical provider. A standardized educational handout explaining the details of AAA with imaging, importance of screening, symptoms and prevention was then mailed out to each of these eligible patients. Resident physicians were educated regarding screening guidelines monthly. After four months, patients were rescreened to assess for improvement.

Results

A total of 345 patients were eligible for AAA screening from 2019 to 2021. Of the 345 eligible patients, 39.1% (135/345) patients had completed screening prior to the initiation of the study, allowing the remaining 210 patients eligible for screening. After four months, only 17% (35/210) received screening; 40% (84/210) did not follow up in the clinic since starting the study and 43% (91/210) continued to follow in the clinic but did not perform the screening. Of the screenings that were completed after starting the study, 43% (15/35) were patients who followed resident physicians as their medical provider, and the remaining 57.1% (20/35) followed attending faculty and mid-level providers. Education regarding AAA screening was delivered to residents only. On completion of the study, a total of 49.3% (170/210) of patients were screened for AAA from 2019 to 2022, indicating a 10.2% improvement.

Conclusion

Our study highlights the importance of educating both patients and providers (including residents and attending faculty) on AAA screening. The initial baseline screening rate was 39.1%, and within four months of implementing an educational patient handout along with resident teaching, 17% of unscreened patients completed the ultrasound imaging. While there was a large set of patients who were lost to follow up, there was an equal amount of patients who still needed screening which can improve with more time. The majority of new screening was done by resident physicians, showing the overall importance of education to enhance screening rates.

Clinical Implications

This study depicts a simpleand straightforward method to promote preventative healthcare screening in an academic clinic setting. Having a successful secondary prevention method can reduce the complications of AAA, including death, and overall improves patient education regarding their medical condition. This study demonstrates that standardized educational handouts can be utilized in the future for other preventative care exams, such as breast cancer screening or vaccination reminders.

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