Building a Structured Field within Clinical Notes in a Migraine Practice: A Quality Improvement Project

Background: Documentation practices in an outpatient migraine clinic describe migraine and headache days (MHD) experienced per month in narrative form within an electronic health record (EHR). Narrative data is time consuming to use in clinic-based research (Meyers et al., 2018). The Model of Improvement’s Plan-Study-Do-Act (PDSA) and the Chronic Care Model (CCM) guided the methodology of this QI project aiming to 1). build a structured field (SF) within an EHR clinical note, and 2). to describe the characteristics of patients who self-record and track their migraine days compared to those who do not. This work includes the first PDSA cycle. Methods: A MHD SF for the EHR clinical note was developed based on the literature review, clinical practice guidelines and informaticists consultation. Migraine clinical patients were recruited and divided into two groups based on whether they kept a record of MHD in a diary or not. Participants completed a questionnaire assessing education level, income, and marital status. A chart review then quantified additional characteristics including age, sex, history of migraine medication use, MHD frequency and severity, age of migraine onset, and zip code. The documented migraine data will be input into the MHD SF once the SF is built. Results: The MHD SF is currently being built. A total of 52 patients have been enrolled for the feasibility portion of the project, 28 tracked MHDs and 24 did not. Migraine characteristics and demographic data were compared between the two groups. There were no statistically significant differences between the groups (p > 0.05) except for the number of preventives tried, which was higher in the documented MHD group (M = 8.89, SD = 5.32) compared to the group that did not keep a diary (M = 5.92, SD = 3.50), p=0.03. Conclusion: The COVID-19 pandemic delayed the construction of the MHD SF. Changes in clinic dynamics and patient access changed with COVID-19 which impacted the original feasibility portion