title: 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.
authors.affiliation: Department of Pediatrics, College of Medicine, University of Florida, 1699 SW 16th Ave, Gainesville, FL, 32608, USA. lathompson@peds.ufl.edu.|Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, USA. lathompson@peds.ufl.edu.
authors.forename: Lindsay A
authors.initials: LA
authors.lastname: Thompson
authors.affiliation: Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, USA.
authors.forename: Martin
authors.initials: M
authors.lastname: Wegman
authors.affiliation: Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Muller
authors.affiliation: Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, USA.
authors.forename: Katie Z
authors.initials: KZ
authors.lastname: Eddleton
authors.affiliation: College of Medicine, Florida State University, Tallahassee, FL, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Muszynski
authors.affiliation: Department of Pediatrics, University of Florida, Jacksonville, FL, USA.
authors.forename: Mobeen
authors.initials: M
authors.lastname: Rathore
authors.affiliation: College of Medicine, Florida State University, Tallahassee, FL, USA.
authors.forename: Jessica
authors.initials: J
authors.lastname: De Leon
authors.affiliation: Department of Pediatrics, College of Medicine, University of Florida, 1699 SW 16th Ave, Gainesville, FL, 32608, USA.|Department of Health Outcomes and Policy, University of Florida, Gainesville, FL, USA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Shenkman
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000592:standards*; D000328:Adult; D003376:Counseling; D005260:Female; D005431:Florida; D017144:Focus Groups; D015438:Health Behavior; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008490:Medical Informatics / Q000379:methods*; D008875:Middle Aged; D000071066:Patient Reported Outcome Measures; D010865:Pilot Projects; D011314:Preventive Health Services / Q000592:standards*; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D018570:Risk Assessment / Q000379:methods*
keywords: Adolescent health services; Counseling/standards; Health behavior; Health care surveys; Health information technology; Patient-reported outcomes; Practice-based research network; Preventive health services; Quality improvement