O2036: Improving STI Screening in Adolescent and Young Adult Males

Purpose/Objectives: The Boston Children’s Hospital (BCH) Adolescent/Young Adult (AYA) practice has consistently screened females for Gonorrhea/Chlamydia (GC/CT) above 90% annually, yet the baseline for males is under 70%. AYA males have unique barriers to screening, including low healthcare utilization, fewer symptoms, and limited testing options during COVID-19 pandemic (urine testing unavailable due to supply chain issues).
Our goal was to increase GC/CT screening in AYA males seen for in-person visits from COVID baseline of 58% annually (summer 2021) to 80% (significantly above pre-COVID high) by July 2022.

Design/Methods: A process map, fishbone diagram, and driver diagram were used to assess core issues and consider interventions. Two Plan, Do, Study, Act (PDSA) cycles were implemented. The first PDSA cycle included adding a bathroom sign stating urine would not be tested without patient’s consent to assuage patient concerns about undesired drug testing. The second PDSA cycle involved creation and implementation of a testing alert for all in-person male medical visits. Our electronic health record (EHR) was used to generate a list of patients with visits during the upcoming week who last had GC/CT testing greater than 13 months prior and thus overdue for annual screening. A note was added to “reason for visit” indicating the patient was overdue for STI testing, prompting clinical assistants to provide a urine cup and clinicians to offer STI testing. A P-chart was used to compare baseline and post-intervention GC/CT testing rates. This study was reviewed by the BCH Department of Pediatrics Performance Excellence Group and determined to not need IRB approval.

Results: Following our first PDSA cycle (bathroom signage), statistical process control chart analysis demonstrated special cause variation with a shift in screening rates from the pandemic baseline of 58% to 65%. Concurrent with this cycle, supply chain issues for urine testing were resolved. Following our second PDSA cycle (testing alert), screening rates increased above pre-pandemic levels at 75%, with consistent increases we continue to monitor. Once the data pull methodology was designed, processing and addition of notation took approximately one person-hour per week.

Conclusion/Discussion: The following interventions have improved GC/CT screening rates among AYA males: bathroom signage regarding need for patient’s consent prior to testing; EHR prompt for clinical assistants and clinicians regarding overdue STI testing. Based on the success of the alert system, we are creating an automated EHR reminder, which will eliminate the current administrative burden. Limitations include possibility of improvements for reasons not directly associated with our intervention, including more in-person visits. Additionally, while on the right trajectory, we have not yet maintained success above our target of 80% because we are examining a lagging measure. We believe our findings are replicable in other practices and require little maintenance once initiated.