B0013 - Impact of an Exocrine Pancreatic Insufficiency Order Set on Adequacy of Management of Exocrine Pancreatic Insufficiency and Related Complications

Michael Ladna, MD¹, Ishaan Madhok, MD¹, Adnan Bhat, MD¹, Nicole Ruiz, MD¹, Jackson Brown, MD¹, Jake Wilson, MD¹, Peter Jiang, MD¹, Mark Radetic, MD¹, Robert Taylor, MD², John George, MD¹, Christopher Forsmark, MD^1
1University of Florida, Gainesville, FL; ²Baton Rouge Clinic, Baton Rouge, LA

Introduction: Exocrine pancreatic insufficiency (EPI) is common in chronic pancreatitis (CP), pancreatic cancer (PDAC), and post pancreatic resection. 40-50% of CP patients, and 70-80% of PDAC patients develop EPI. Only about 1/3 of these patients are prescribed pancreatic enzyme replacement therapy (PERT), often at an inadequate dose, with evidence that this leads to increased morbidity and mortality. The aim of this study was to develop and implement an EPIC-based best practice alert (BPA) and smart set with goal of improving management of EPI.

Methods: All patients with ICD-10 codes of EPI, CP, and PDAC or CPT code for pancreatic resection, who were seen in either an outpatient or inpatient setting at a tertiary care center from Feb-2018 to Feb-2021 were included. Data was extracted from the institution’s integrated electronic data repository. This study was approved by the institutional review board. Appropriate use of PERT was defined as > 40,000 USP units of lipase with each meal. The initial retrospective analysis was conducted prior to implementation of the BPA and smart set from feb-2018 to feb-2020. The BPA and smart set were implemented on Feb-2020 and another retrospective analysis was done on patients from feb-2020 to feb-2021. The BPA fired if patient were already on PERT or if provider placed an order for PERT. The BPA would provide link to smart set which had appropriate PERT doses prefilled.

Results: A statistically significant increase in the proportion of patients on minimum therapeutic dose of PERT from 61.9 to 72.9% (P=< 0.001) was observed. Ordering of pancreatic elastase, A1c, vitamin D, and DEXA all increased from 20.4 to 29.9% (P< 0.001), 54.7 to 62.1% (P=0.001), 30.9 to 48.1% (P< 0.001) and 10 to 18% (P< 0.001), respectively after initiation of BPA and smart set. An increase in vitamin D supplementation from 25.5 to 33.4% (P< 0.001) and a decrease in the proportion of patients with unknown metabolic bone disease status from 86.8 to 76.8% (P< 0.001) was observed.

Discussion: EPI smart set usage was associated with an increase in ordering of pancreatic elastase, A1c, vitamin D, DEXA as well as an increase in the proportion of patients on minimum therapeutic dose of enzyme despite no change in the proportion of patients following with a gastroenterologist. There was no change in the proportion of patients on PERT, which was likely explained by the constraints of BPA since it did not fire if the patient was not already on PERT or if the physician was not ordering PERT.




Disclosures:


Michael Ladna, MD¹, Ishaan Madhok, MD¹, Adnan Bhat, MD¹, Nicole Ruiz, MD¹, Jackson Brown, MD¹, Jake Wilson, MD¹, Peter Jiang, MD¹, Mark Radetic, MD¹, Robert Taylor, MD², John George, MD¹, Christopher Forsmark, MD¹. B0013 - Impact of an Exocrine Pancreatic Insufficiency Order Set on Adequacy of Management of Exocrine Pancreatic Insufficiency and Related Complications, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.