Improving Adolescent Health Risk Assessment: A Multi-method Pilot Study
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Improving Adolescent Health Risk Assessment: A Multi-method Pilot Study Lindsay A. Thompson1,2 • Martin Wegman2 • Keith Muller2 • Katie Z. Eddleton2 • Michael Muszynski3 • Mobeen Rathore4 • Jessica De Leon3 • Elizabeth A. Shenkman1,2 the Health IMPACTS for Florida Network
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Published online: 12 July 2016 Ó The Author(s) 2016. This article is published with open access at Springerlink.com
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). & Lindsay A. Thompson [email protected] 1
Department of Pediatrics, College of Medicine, University of Florida, 1699 SW 16th Ave, Gainesville, FL 32608, USA
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Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, USA
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College of Medicine, Florida State University, Tallahassee, FL, USA
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Department of Pediatrics, University of Florida, Jacksonville, FL, USA
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. Keywords Adolescent health services Preventive health services Health information technology Counseling/standards Health care surveys Health behavior Quality improvement Practice-based research network Patient-reported outcomes Abbreviations HIT Health information technology HRA Health risk assessment
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