- Email: [email protected]
Adolescent and Young Adult Reported Receipt of Confidential Clinical Preventive Services, United States, 2016
Poster Abstracts / 60 (2017) S39eS82
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in a busy office setting. The electronic health record (EHR) has the ability to fill these gaps by giving primary care providers the tools they need to efficiently and effectively address transition with youth and families. We sought to develop, implement, and test EHR-integrated Transition Planning Tools (ETPTs) in a primary care setting to determine their usefulness in improving transition experience for youth and families. Methods: We used Plan-Do-Study-Act (PDSA) methodology in an academic adolescent medicine primary care clinic. We targeted providers and focused on well visits for youth age 17 to 25. Provider transition practice and knowledge was assessed at baseline, and will be compared to post-intervention surveys. At baseline and after each PDSA cycle, we reviewed charts to assess use of ETPTs, and surveyed youth and parents on their experiences during well visits. The ETPTs consisted of: 1) readiness assessment, 2) referral process for readiness support, 3) informational brochure including transition policy, 4) documentation templates for progress notes, and 5) use of ICD9/10 code for transition counseling in visit diagnosis. Four cycles focused on improving provider use of the ETPTs using inperson training, reference cards, incentives, and daily reminders. Proportions are reported from baseline and first 2 cycles, given that cycle 3 is in progress. Percent difference between baseline and cycle 2, and corresponding Chi-squared p values are reported. Results: At baseline, 3/16 (19%) of providers used a standardized readiness assessment, and 6/16 (38%) were aware of existing policy on transition. We trained 35 providers, including 20 residents, on the importance of transition and ETPT use. Over six months, we implemented 2 of 4 planned cycles described above, with each cycle lasting 2-3 months. Surveys of parents (n¼5, 7, and 4 at baseline, cycle 1, and cycle 2 respectively) and youth (n¼11, 23, 11, respectively) showed improvement in those who reported their provider discussed transition during the visit (Youth: baseline 36%, cycle 1 52%, cycle 2 82%; difference + 46%; p<0.05; Parents: 20, 43, 75%; +55%; p¼0.12), and received written information about transition (Youth: 27, 39, 82%; +55%; p<0.05; Parents: 0, 29, 50%; +50%; p¼0.09). Chart reviews (n¼9,10, and 69 at baseline, cycle 1, and cycle 2, respectively) showed that documentation outcomes did not improve after cycle 1, and did improve after cycle 2, but did not reach statistical significance; specifically ICD9/10 code use (0, 0, 7%, +7%, p¼0.42), readiness assessment completion (0, 0, 21%; +21%; p¼0.13), and written information in After Visit Summary (0, 0, 13%, +13%, p¼0.25). Conclusions: An EHR-integrated intervention that includes provider training and reminders can increase frequency of transition discussion as measured by provider documentation and youth and parent report. Sources of Support: Adolescent Health Promotion Research Training Program (T32HD052459-07); LEAH (T71MC08054); Parents Place of Maryland (120582).
Purpose: Confidentiality is an essential component of adolescent health care delivery and of effective clinical preventive services (CPS). In clinic-based studies, adolescents and young adults (AYA) place great value on confidentiality; population data about AYA receipt of confidential services are less commonly available. Methods: We surveyed a nationally representative sample of 1,918 13-26 year old AYAs and 1,209 parents of 13-18 year olds in the US about their knowledge, attitudes, and experiences with confidentiality and preventive care visits between May and July 2016. Survey questionnaire domains based on prior literature, formative research, and the information-motivation-behavior skills (IMB) conceptual model included attitudes towards preventive services, confidentiality, and private time; health care seeking behaviors; access to health information; risk behaviors; and demographics. Stratified samples of young adults (19-26 years) and adolescents (13-18 years) and parents were weighted to be representative of all U.S. households with AYAs and analyzed by estimating the weighted marginal and conditional proportions for each variable of interest, stratified by age and gender. The weighted analysis sample was 55% white, 22% Latino, 14% Black, 3% > 2 races, and 6% other race. Results: Ninety percent (90%) thought that it is important or very important that AYAs receive preventive visits; this finding did not vary by age. Females were more likely than males to report that preventive visits were very important (58% vs. 47%, respectively). Only 49% of AYAs reported that a health care provider had ever talked to them about confidentiality; rates ranged from 22-26% in both genders among 13-14 year olds, to 70-76% in those ages 1920. Only 52% of participants reported ever having a private conversation with a health care provider, ranging from only 15% of 13 year olds to 82% of 24 year olds for females, and 12% of 14 year olds and 76% of 19 year olds for males. Conclusions: Although private time and preventive care are important to adolescents and young adults, only about half reported receiving these services. These data support the importance of working with health professionals, parents, adolescents, and young adults to overcome barriers to care and to optimize receipt of adolescent clinical preventive services. Sources of Support: Merck Foundation Grant.
116.
1
ADOLESCENT AND YOUNG ADULT REPORTED RECEIPT OF CONFIDENTIAL CLINICAL PREVENTIVE SERVICES, UNITED STATES, 2016 Marina Catallozzi, MD 1, Xiaoyu Song, DrPH 2, Jill Humphrey, RN 2, Kristen Kaseeska, MPH 3, Mary C. Boyle, MBBS 2, Julie Gorzkowski, MSW 3, Xianling Wang, BS 2, Jennifer Heitel, MPH 2, John S. Santelli, MD, MPH, FSAHM 2, Jonathan D. Klein, MD, MPH 3. 1
Columbia University Medical Center; 2Mailman School of Public Health; 3American Academy of Pediatrics.
RESEARCH POSTER PRESENTATIONS: HOMELESS YOUTH 117. IF YOU ASK, THEY WILL TELL: IDENTIFYING RISK FOR HUMAN TRAFFICKING AMONG HOMELESS YOUTH Salina Mostajabian, MD 1, Claire Bocchini, MD 1, Constance M. Wiemann, PhD, FSAHM 1, Diane Santa Maria, DrPH 2. Baylor College of Medicine; 2The University of Texas Health Science Center at Houston.
Purpose: This study evaluates the use of a focused screening tool compared with general psycho-social screening (HEADDSS) to identify trafficking risk factors and experiences in homeless adolescents in a United States human trafficking hub. Methods: Cross sectional study of a convenience sample of youth (ages 18-21) receiving care at a clinic within a homeless shelter (May-November 2016, target n¼120). Data collection included an anonymous structured screening tool (SST; developed by Urban
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in a busy office setting. The electronic health record (EHR) has the ability to fill these gaps by giving primary care providers the tools they need to efficiently and effectively address transition with youth and families. We sought to develop, implement, and test EHR-integrated Transition Planning Tools (ETPTs) in a primary care setting to determine their usefulness in improving transition experience for youth and families. Methods: We used Plan-Do-Study-Act (PDSA) methodology in an academic adolescent medicine primary care clinic. We targeted providers and focused on well visits for youth age 17 to 25. Provider transition practice and knowledge was assessed at baseline, and will be compared to post-intervention surveys. At baseline and after each PDSA cycle, we reviewed charts to assess use of ETPTs, and surveyed youth and parents on their experiences during well visits. The ETPTs consisted of: 1) readiness assessment, 2) referral process for readiness support, 3) informational brochure including transition policy, 4) documentation templates for progress notes, and 5) use of ICD9/10 code for transition counseling in visit diagnosis. Four cycles focused on improving provider use of the ETPTs using inperson training, reference cards, incentives, and daily reminders. Proportions are reported from baseline and first 2 cycles, given that cycle 3 is in progress. Percent difference between baseline and cycle 2, and corresponding Chi-squared p values are reported. Results: At baseline, 3/16 (19%) of providers used a standardized readiness assessment, and 6/16 (38%) were aware of existing policy on transition. We trained 35 providers, including 20 residents, on the importance of transition and ETPT use. Over six months, we implemented 2 of 4 planned cycles described above, with each cycle lasting 2-3 months. Surveys of parents (n¼5, 7, and 4 at baseline, cycle 1, and cycle 2 respectively) and youth (n¼11, 23, 11, respectively) showed improvement in those who reported their provider discussed transition during the visit (Youth: baseline 36%, cycle 1 52%, cycle 2 82%; difference + 46%; p<0.05; Parents: 20, 43, 75%; +55%; p¼0.12), and received written information about transition (Youth: 27, 39, 82%; +55%; p<0.05; Parents: 0, 29, 50%; +50%; p¼0.09). Chart reviews (n¼9,10, and 69 at baseline, cycle 1, and cycle 2, respectively) showed that documentation outcomes did not improve after cycle 1, and did improve after cycle 2, but did not reach statistical significance; specifically ICD9/10 code use (0, 0, 7%, +7%, p¼0.42), readiness assessment completion (0, 0, 21%; +21%; p¼0.13), and written information in After Visit Summary (0, 0, 13%, +13%, p¼0.25). Conclusions: An EHR-integrated intervention that includes provider training and reminders can increase frequency of transition discussion as measured by provider documentation and youth and parent report. Sources of Support: Adolescent Health Promotion Research Training Program (T32HD052459-07); LEAH (T71MC08054); Parents Place of Maryland (120582).
Purpose: Confidentiality is an essential component of adolescent health care delivery and of effective clinical preventive services (CPS). In clinic-based studies, adolescents and young adults (AYA) place great value on confidentiality; population data about AYA receipt of confidential services are less commonly available. Methods: We surveyed a nationally representative sample of 1,918 13-26 year old AYAs and 1,209 parents of 13-18 year olds in the US about their knowledge, attitudes, and experiences with confidentiality and preventive care visits between May and July 2016. Survey questionnaire domains based on prior literature, formative research, and the information-motivation-behavior skills (IMB) conceptual model included attitudes towards preventive services, confidentiality, and private time; health care seeking behaviors; access to health information; risk behaviors; and demographics. Stratified samples of young adults (19-26 years) and adolescents (13-18 years) and parents were weighted to be representative of all U.S. households with AYAs and analyzed by estimating the weighted marginal and conditional proportions for each variable of interest, stratified by age and gender. The weighted analysis sample was 55% white, 22% Latino, 14% Black, 3% > 2 races, and 6% other race. Results: Ninety percent (90%) thought that it is important or very important that AYAs receive preventive visits; this finding did not vary by age. Females were more likely than males to report that preventive visits were very important (58% vs. 47%, respectively). Only 49% of AYAs reported that a health care provider had ever talked to them about confidentiality; rates ranged from 22-26% in both genders among 13-14 year olds, to 70-76% in those ages 1920. Only 52% of participants reported ever having a private conversation with a health care provider, ranging from only 15% of 13 year olds to 82% of 24 year olds for females, and 12% of 14 year olds and 76% of 19 year olds for males. Conclusions: Although private time and preventive care are important to adolescents and young adults, only about half reported receiving these services. These data support the importance of working with health professionals, parents, adolescents, and young adults to overcome barriers to care and to optimize receipt of adolescent clinical preventive services. Sources of Support: Merck Foundation Grant.
116.
1
ADOLESCENT AND YOUNG ADULT REPORTED RECEIPT OF CONFIDENTIAL CLINICAL PREVENTIVE SERVICES, UNITED STATES, 2016 Marina Catallozzi, MD 1, Xiaoyu Song, DrPH 2, Jill Humphrey, RN 2, Kristen Kaseeska, MPH 3, Mary C. Boyle, MBBS 2, Julie Gorzkowski, MSW 3, Xianling Wang, BS 2, Jennifer Heitel, MPH 2, John S. Santelli, MD, MPH, FSAHM 2, Jonathan D. Klein, MD, MPH 3. 1
Columbia University Medical Center; 2Mailman School of Public Health; 3American Academy of Pediatrics.
RESEARCH POSTER PRESENTATIONS: HOMELESS YOUTH 117. IF YOU ASK, THEY WILL TELL: IDENTIFYING RISK FOR HUMAN TRAFFICKING AMONG HOMELESS YOUTH Salina Mostajabian, MD 1, Claire Bocchini, MD 1, Constance M. Wiemann, PhD, FSAHM 1, Diane Santa Maria, DrPH 2. Baylor College of Medicine; 2The University of Texas Health Science Center at Houston.
Purpose: This study evaluates the use of a focused screening tool compared with general psycho-social screening (HEADDSS) to identify trafficking risk factors and experiences in homeless adolescents in a United States human trafficking hub. Methods: Cross sectional study of a convenience sample of youth (ages 18-21) receiving care at a clinic within a homeless shelter (May-November 2016, target n¼120). Data collection included an anonymous structured screening tool (SST; developed by Urban