A simple approach to improve recording of concerns about child maltreatment in primary care records: developing a quality improvement intervention.
BACKGROUND
Information is lacking on how concerns about child maltreatment are recorded in primary care records.


OBJECTIVE
To determine how the recording of child maltreatment concerns can be improved.


METHODS
Development of a  quality improvement intervention involving: clinical audit, a descriptive survey, telephone interviews, a workshop, database analyses, and consensus development in UK general practice.


METHODS
Descriptive analyses and incidence estimates were carried out based on 11 study  practices and 442 practices in The Health Improvement Network (THIN). Telephone interviews, a workshop, and a consensus development meeting were conducted with lead GPs from 11 study practices.


RESULTS
The rate of children with at least one maltreatment-related code was  8.4/1000 child years (11 study practices, 2009-2010), and 8.0/1000 child years (THIN, 2009-2010). Of 25 patients with known maltreatment, six had no maltreatment-related codes recorded, but all had relevant free text, scanned documents, or codes. When stating their reasons for  undercoding maltreatment concerns, GPs cited damage to the patient relationship, uncertainty about which codes to use, and having concerns about recording information on other family members in the child's records. Consensus recommendations are to record the code 'child is cause  for concern' as a red flag whenever maltreatment is considered, and to use a list of codes arranged around four clinical concepts, with an option for a templated short data entry form.


CONCLUSIONS
GPs under-record maltreatment-related concerns in children's electronic  medical records. As failure to use codes makes it impossible to search or audit these cases, an approach designed to be simple and feasible to implement in UK general practice was recommended.
UCL Institute of Child Health, MRC Centre of Epidemiology for Child Health and Centre for Evidence-Based Child Health, London.
Jenny
J
Woodman
Janice
J
Allister
Imran
I
Rafi
Simon
S
de Lusignan
Jonathan
J
Belsey
Irene
I
Petersen
Ruth
R
Gilbert
D017677:Age Distribution; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data*; D059019:Clinical Coding; D004739:England; D058006:General Practice / Q000592:standards*; D006801:Humans; D008485:Medical Audit; D008499:Medical Records / Q000592:standards*; D010818:Practice Patterns, Physicians'; D058996:Quality Improvement