Improving Adolescent Health Risk Assessment: A Multi-method Pilot Study

Abstract

Objectives Given poor compliance by providers with adolescent health risk assessment (HRA) in primary care, we describe the development and feasibility of using a health information technology (HIT)-enhanced HRA to improve the frequency of HRAs in diverse clinical settings, asking adolescents’ recall of quality of care as a primary outcome. Methods We conducted focus groups and surveys with key stakeholders (Phase I) , including adolescents, clinic staff and providers to design and implement an intervention in a practice-based research network delivering private, comprehensive HRAs via tablet (Phase II). Providers and adolescents received geo-coded community resources according to individualized risks. Following the point-of-care implementation , we collected patient-reported outcomes using post-visit quality surveys (Phase III). Patient-reported outcomes from intervention and comparison clinics were analyzed using a mixed-model, fitted separately for each survey domain. Results Stakeholders agreed upon an HIT-enhanced HRA (Phase I). Twenty-two academic and community practices in north-central Florida then recruited 609 diverse adolescents (14–18 years) during primary care visits over 6 months; (mean patients enrolled = 28; median = 20; range 1–116; Phase II). Adolescents receiving the intervention later reported higher receipt of confidential/private care and counseling related to emotions and relationships (adjusted scores 0.42 vs 0.08 out of 1.0, p < .01; 0.85 vs 0.57, p < .001, respectively, Phase III) than those receiving usual care. Both are important quality indicators for adolescent well-child visits. Conclusions Stakeholder input was critical to the acceptability of the HIT-enhanced HRA. Patient recruitment data indicate that the intervention was feasible in a variety of clinical settings and the pilot evaluation data indicate that the intervention may improve adolescents’ perceptions of high quality care.

Integrating and coordinating care between the Women, Infants, and Children Program and pediatricians to improve patient-centered preventive care for healthy growth

“…Secure and confidential health information exchange, conforming to the rules of HIPAA, has been demonstrated, suggesting that this can be achieved between clinical and public health services [7,29]. Furthermore, HIT can assist providers in integrating standardized procedures and recommendations into their workflow while improving patient care [30] and health outcomes while remaining acceptable to patients [31]. With care coordination occurring in the healthcare setting, there are models in place to inform a system that would allow communication and data sharing between WIC nutritionists and pediatricians although flexible governance solutions should be mutually identified and practiced with continuous attention to internal factors (e.g., time) and external factors (e.g., economic costs) [26,27].…”

Improving Patient-Centered Care for Young People in General Practice With a Codesigned Screening App: Mixed Methods Study

“…This difference may be due to measuring patient-centered care by analyzing audio recordings of consultations, rather than patient’s own ratings. Another recently published study found no changes in communication and experience of care, or in health information [ 56 ]. However, both of these studies were conducted with young people at well visits, which are not well-attended by key subgroups of young people such as low income and uninsured [ 14 ].…”

Assessing the Effect of School‐Based Health Centers on Achievement of National Performance Measures

“…As noted previously, NSBHA adopted a set of core clinical performance measures that align with national child quality best practices in developing the NPMs. The importance of these 5 NPMs: (1) annual well‐child visit, (2) annual risk assessment, (3) BMI assessment and nutrition and physical activity counseling, (4) depression screening and follow‐up plan for a positive screen, and (5) chlamydia screening cannot be understated given the disparities 27‐30 …”