{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T13:57:25Z","timestamp":1782223045535,"version":"3.54.5"},"reference-count":20,"publisher":"BMJ","issue":"3","license":[{"start":{"date-parts":[[2020,4,19]],"date-time":"2020-04-19T00:00:00Z","timestamp":1587254400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Scleroderma and Related Disorders"],"published-print":{"date-parts":[[2020,10]]},"abstract":"\n Background:<\/jats:title>\n Pulmonary arterial hypertension is a life-limiting complication in patients with systemic sclerosis. Current recommendations suggest a minimum screening of an annual transthoracic echocardiogram and pulmonary function test. We hypothesize that modifiable provider-level hurdles contribute to inadequate screening and can be alleviated.<\/jats:p>\n <\/jats:sec>\n \n Methods and Results:<\/jats:title>\n We performed a longitudinal study over 23\u2009months of all systemic sclerosis patients seen in pulmonary and\/or rheumatology clinics. Pulmonary arterial hypertension screening was measured monthly as percentage of patients with up-to-date transthoracic echocardiogram and pulmonary function test out of the total systemic sclerosis patients with an outpatient encounter that month. Tests were considered \u201cup-to-date\u201d if they were performed 12\u2009months prior or within the next 6\u2009months post-encounter. Baseline adherence to PAH screening was assessed using a 9-month preproject period. Physicians in rheumatology and pulmonary clinics were surveyed for knowledge and perceived as barriers to screening. Interventions focused on provider-level hurdles to improve the screening rate to >90%. Adherence to systemic sclerosis\u2013associated pulmonary arterial hypertension was compared between baseline and post-intervention phases as a continuous variable using nonparametric Mann\u2013Whitney\u2013Wilcoxon test and as categorical variable using chi-square test for overall adherence rate. A total of 18 providers were surveyed, of which 67% knew minimal screening recommendations and 44% identified \u201cdifficulty ordering tests\u201d as a barrier. Our interventions were as follows: (1) didactic education and literature dissemination and (2) best practice alert in the electronic medical record to facilitate just-in-time ordering of screening. Adherence was measured for 23\u2009months, comprising 166 systemic sclerosis patients. Monthly adherence to pulmonary arterial hypertension screening increased by 10.4% (69.2%\u201379.6%, p\u2009=\u20090.01 with chi-square and p\u2009=\u20090.09 with Mann\u2013Whitney\u2013Wilcoxon test), with an increase in transthoracic echocardiogram by 7.5% and pulmonary function test by 4.9%.<\/jats:p>\n <\/jats:sec>\n \n Conclusion:<\/jats:title>\n Provider-level hurdles contribute to sub-optimal systemic sclerosis\u2013associated pulmonary arterial hypertension screening. Lack of knowledge and difficulty in ordering tests were major barriers. Structured education and decision-support aids improve screening. These interventions, however, were insufficient to improve screening to a goal target of >90%.<\/jats:p>\n <\/jats:sec>","DOI":"10.1177\/2397198320913686","type":"journal-article","created":{"date-parts":[[2020,4,20]],"date-time":"2020-04-20T01:32:32Z","timestamp":1587346352000},"page":"219-223","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":3,"title":["Improving adherence to pulmonary hypertension screening in patients with systemic sclerosis: Overcoming the provider-level barriers"],"prefix":"10.1136","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3974-2760","authenticated-orcid":false,"given":"Gregory W","family":"Wigger","sequence":"first","affiliation":[{"name":"Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, Emory University School of Medicine, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad A","family":"Zafar","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean M","family":"Elwing","sequence":"additional","affiliation":[{"name":"Division of Pulmonary, Critical Care, and Sleep Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,4,19]]},"reference":[{"key":"bibr1-2397198320913686","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.100245"},{"key":"bibr2-2397198320913686","doi-asserted-by":"publisher","DOI":"10.1378\/chest.12-0653"},{"key":"bibr3-2397198320913686","doi-asserted-by":"publisher","DOI":"10.1002\/art.30541"},{"key":"bibr4-2397198320913686","doi-asserted-by":"publisher","DOI":"10.1038\/nrcardio.2014.191"},{"key":"bibr5-2397198320913686","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehv317"},{"key":"bibr6-2397198320913686","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2013-203301"},{"key":"bibr7-2397198320913686","doi-asserted-by":"publisher","DOI":"10.1002\/art.38172"},{"key":"bibr8-2397198320913686","doi-asserted-by":"publisher","DOI":"10.1186\/ar3876"},{"key":"bibr9-2397198320913686","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200811-1691OC"},{"key":"bibr10-2397198320913686","doi-asserted-by":"publisher","DOI":"10.1186\/s13075-015-0517-5"},{"key":"bibr11-2397198320913686","doi-asserted-by":"publisher","DOI":"10.1002\/art.10775"},{"key":"bibr12-2397198320913686","doi-asserted-by":"publisher","DOI":"10.1002\/hep.29362"},{"key":"bibr13-2397198320913686","doi-asserted-by":"publisher","DOI":"10.3899\/jrheum.110121"},{"issue":"1","key":"bibr14-2397198320913686","volume":"19","author":"Morrisroe K","year":"2017","journal-title":"Arthritis Res Ther"},{"key":"bibr15-2397198320913686","doi-asserted-by":"publisher","DOI":"10.1158\/1055-9965.EPI-14-1241"},{"key":"bibr16-2397198320913686","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtho.2016.06.010"},{"key":"bibr17-2397198320913686","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2017.02.012"},{"key":"bibr18-2397198320913686","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.132.3.354"},{"key":"bibr19-2397198320913686","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM198911093211906"},{"key":"bibr20-2397198320913686","doi-asserted-by":"publisher","DOI":"10.1186\/s12911-017-0430-8"}],"container-title":["Journal of Scleroderma and Related Disorders"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2397198320913686","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/2397198320913686","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/2397198320913686","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T11:52:47Z","timestamp":1777981967000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/2397198320913686"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,4,19]]},"references-count":20,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2020,10]]}},"alternative-id":["10.1177\/2397198320913686"],"URL":"https:\/\/doi.org\/10.1177\/2397198320913686","relation":{},"ISSN":["2397-1983","2397-1991"],"issn-type":[{"value":"2397-1983","type":"print"},{"value":"2397-1991","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,4,19]]}}}