O2005: Implementation of an Electronic Pre-visit Adolescent Health Questionnaire Across a Diverse Pediatric Primary Care Network

Purpose/Objectives:

Purpose: Early detection of adolescent risk behaviors through preventive health visits can improve health management and appropriate referral to care. However, such behaviors have historically not been routinely captured in a meaningful or systematized way. Preventative care serves as a key role in both promoting healthy behaviors among adolescents and initiating conversations about topics that may otherwise not be addressed.

Objective: To increase the percentage of adolescent well visits with a completed Adolescent Health Questionnaire (AHQ) to 80% across the CHOP Primary Care Network by January 2022.

Design/Methods: The AHQ was developed by an interdisciplinary team of pediatric clinicians, researchers, and clinical informaticians and embedded within the electronic health record (EHR)(EPIC). The instrument was created from items designed to gather historical information and from validated questionnaires. Questions were organized into eight health domains (Figure 1). Prior to implementation, usability testing was performed with a pilot sample of providers to identify key system features to support workflow integration. We also conducted a focus group with adolescents to review and refine each question for clarity. Implementing the AHQ occurred through a phased approach within three PDSA cycles. Cycle 1 was a single pilot site – a large, diverse, urban clinic – where we performed real-time observations to understand how well the AHQ integrated into the office and visit workflow. We received iterative feedback from clinicians and office staff that allowed us to incorporate changes into the next cycle. Cycle 2 included early adopters, or sites interested in incorporating the AHQ into their office workflow. Cycle 3 involved the remaining sites across the Care Network. Outcomes measured between each implementation cycle were practice-level AHQ completion rates. Secondary outcomes included qualitative feedback from clinicians and office staff on their use of the AHQ.

Results: From January 2020 to January 2022, the AHQ was implemented through a staggered approach at 31 primary care practices across urban, suburban, and rural settings within the Care Network. Since January 2020, 89% (n=26,222) of eligible teens (age 13-19 years-old) have completed the screener at their well child visit. Completion rates did not meaningfully differ by practice location (median: 93.5%; range: 75-98%) (Figure 2). Sociodemographic characteristics of patients who completed the AHQ include: 50% male, 55% 13-15-year-olds, 48% Non-Hispanic Black, 7% Hispanic, and 46% with public insurance.

Conclusion/Discussion: The network-wide AHQ completion rate is 89%, surpassing our goal of 80% in the first two years of implementation. Results demonstrate implementation feasibility across a diverse population of adolescents in a range of practice settings within a large primary care network. The AHQ will serve as a valuable data source to guide future efforts involving the integration of appropriate clinical decision support to translate screening into brief interventions and referral to treatment, as needed.