Research In Practice Blog
Accelerating Innovation in Primary Care to Support Adolescent Health Discussions
Intro
For physicians, defining the scope of conversation topics to be covered during an annual doctor’s visit can be difficult. Adolescent patients can present with an infinite combination of issues, questions, and scenarios, and life experiences vastly differ from patient to patient.
While many pediatricians utilize the robust documentation capabilities in their EHRs, no existing system captures the complete range of datapoints across all patient discussions. One group of physician researchers observed that data collection of preventive health visit discussions about adolescent strengths, identities, and risk behaviors—which is especially helpful in assessing wellbeing, benchmarking, and developing and evaluating interventions—was lacking. So, they developed and implemented an EHR-embedded adolescent health questionnaire (AHQ) and usage model that has now been adopted by more than 30 primary care practices.
Video Abstract
Watch this video abstract to learn more.
Design and Deployment
First, the researchers aggregated questions from numerous validated adolescent screening tools. For AHQ administration, they selected a pre-visit, in-office, tablet-administered format. Pre-visit timing is proven to be most efficient for both clinicians and patients, and it invites patients to be thoughtful about their responses. Tablet computer delivery was chosen for efficiency, facilitation of direct patient responses (not parent-mediated), and patient confidentiality.
Next, they created the response reports delivered via the EHR. For clinicians, all AHQ patient responses are viewable. However, to maximize efficiency and utility, responses that warrant discussion or follow-up are flagged and presented in an actionable summary, to drive discussions during the patient’s visit. For caregivers and parents with access to patient records, minimal detail is provided, in consideration of patient privacy.
Iteration and Refinement
The AHQ system was pilot-tested for 15 months at one large clinic and was refined through rapid learning cycles and iterative intervention development. The researchers continually assessed workflow impact and feedback from clinicians, patients, and parents/caregivers, then revised accordingly.
Then, they scaled the AHQ system across 31 primary care practice sites and closely monitored usage metrics and success measures. During this 24-month phase, more than 88% of adolescents completed the AHQ at their scheduled preventive visits. Feedback and data were examined, and chart review was conducted.
Implications
Prior to AHQ adoption, in-EHR adolescent health screening data was limited to tobacco use and school information. With the AHQ system, available screening data includes strengths, nutrition, physical activity, family and friends, gun safety, alcohol & substance abuse, sexual activity, sexual orientation, and gender identity. Of the more than 100,000 AHQ encounters, fewer than 5 parents/caregivers expressed concerns and most adolescents (72%) expressed a preference for the electronic questionnaire.
This study demonstrates that health information can be collected in an efficient, confidential manner directly from adolescents in a manner accounts for clinician lack of time and patient privacy concerns. The researchers view the AHQ system as foundational for additional interventions and better care and ultimately for establishing a comprehensive adolescent health platform.
Additional Information, Resources, and Media Coverage:
AAP Video Abstract
CHOP Adolescent Health Questionnaire
"Electronic questionnaire helps primary care practices collect health info on teens"- Published in Healio on June 12, 2024
"Preventing Gun Violence, Supporting Adolescent Health Discussions" - Published in American Academy of Pediatrics on June 12, 2024
"CHOP-Developed Adolescent Health Questionnaire Helps Doctors and Families Navigate Complex Issues" - CHOP News Release Published on June 13, 2024
"New adolescent health questionnaire helps doctors and families navigate complex issues" - Published in Medical Press on June 13, 2024
Clinical Futures author(s):
Brian P. Jenssen, MD, MSHP; Gabrielle DiFiore, MPH; Maura Powell, MPH, MBA; George Dalembert, MD, MSHP; Sarah Wood, MD, MSHP; Alexander G. Fiks, MD, MSCE
Additional study author(s) from Children’s Hospital of Philadelphia:
Anthony Luberti, MD; Angela Rapposelli; Gregory Lawton, MD; Carol A. Ford, MD; Lisa Biggs, MD