(71) Verification of co-morbid diagnosis of Depression and Anxiety in adolescents with Cystic Fibrosis after change in Electronic Medical Record (EMR)

Background: The CFF provides program specific reports annually. Registry data however is only accurate if it is entered appropriately. All providers in the multi-disciplinary team review the program specific report as part of our ongoing quality improvement efforts. The CF team noticed a significant increase in those diagnosed with depression and anxiety from 2019 to 2020. Our center was also significantly higher than other pediatric centers. In 2020, the pandemic was noted to cause significant depression and anxiety issues in adolescents. However, in 2020 our hospital system underwent a change in EMR and problem lists which include medical diagnoses such as depression, anxiety and cystic fibrosis were imported automatically or coded directly by non-clinical personnel from the organization. We thus performed a study to determine if there was an increase in diagnosed depression and anxiety versus misclassification due to medical record data entry.

Methods: Registry data was reviewed by the CF Mental Health Coordinator (MHC) and the CF Registry Coordinator. Patients who were coded as having depression and anxiety in the 2020 finalized data were assessed. The registry data was compared to the patient’s medical chart. Our institution had undergone a change in the electronic medical record in October, 2020 so medical notes were reviewed in both systems. Patients were classified to have a diagnosis of depression and/or anxiety if this was diagnosed in the medical chart with an encounter by a Psychiatrist, Psychiatric ARNP, Psychiatric PA, and/or the patient had long-term use of a psychotropic medication used to treat depression and/or anxiety. If the diagnosis only existed in the problem list but no other information found, it was classified as not depression and/or anxiety. Any change in classification was also adjudicated by the Center Director.

Results: In 2020 registry data, it was noted that 12.0% (19 of 159) of clinic patients were indicated to have depression compared to 5.2% within pediatric programs. 12.7% (20 of 159) of clinic patients were indicated to have anxiety compared to 6.3% in pediatric programs. Additionally, this was an increase from 6.7% (11 of 165) and 9.8% (16 of 165) respectively in 2019. After review of charts for use of medications and supportive documentation of a diagnosis from psychiatry, only 4% (7 of 159) of patients were diagnosed and/or being treated for depression and 6% (10 of 159) of patients were diagnosed and/or being treated for anxiety. The majority of patients were found to have misclassification due to problem list diagnosis which was not confirmed by actual medical records from psychiatry. A deeper review showed that patients in the old EMR diagnosed with procedural phobia or situational anxiety were now diagnosed with anxiety or depression. These diagnoses were removed from the patient’s medical record.

Conclusions: 2020 was a significantly stressful time for all people with CF and it was plausible that there was indeed an increase in depression and anxiety in our adolescent population. However, this study shows that accurate medical chart information is vital to registry entry. During any change in medical records, reverification of data will be necessary. In the future, the clinical staff will continue to review registry reports for any significant discrepancy and compare to the patient’s medical chart for ongoing accuracy in reporting.

Acknowledgements:

References: