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- All Subjects: Electronic Health Records
- All Subjects: Health education
- Creators: Jacobson, Diana
- Resource Type: Text
Background: Healthcare providers are encouraged to prepare their practice to effectively manage the care of mild to moderate adolescent depression. Cost-effective screening, diagnostic, and newly developed pediatric primary care depression management guidelines have been established. To integrate guidelines into practice, primary care providers (PCPs) must document effectively to ensure a complete treatment plan is in place in the patient’s electronic health record (EHR).
Intervention: Elements from a flowsheet were implemented into the EHR to promote thorough assessment and documentation of care delivered to adolescents with depression.
Methods: An initial chart review was completed on patients diagnosed with depression. An updated depression template was implemented within the EHR for six weeks. A follow-up chart review was completed post-intervention to determine if documentation of elements from the adolescent depression guidelines improved after the EHR update. Pre-intervention and post- intervention surveys were delivered to PCP’s to understand their perspective on adolescent depression management.
Outcomes: The chart review revealed that baseline PHQ-9 screenings were documented in 91% (n=43) of the charts reviewed in the pre-intervention timeframe. Only 78% (n=7) of the charts reviewed during post-intervention included PHQ-9 screenings. Early intervention treatment options documented in the pre-intervention timeframe included education 100% (n=47), medication prescriptions 53% (n=25), and psychotherapy referrals 18% (n=18). During post- intervention, education 100% (n=9), medication prescriptions 78% (7), and psychotherapy referrals 22% (n=7) were documented by the PCPs.
Recommendation: The quality improvement project focused heavily on documentation completed over a one year pre-intervention timeframe compared to a six-week post-intervention timeframe. Further evaluation and chart review over the next year will provide a more adequate comparison of documentation within primary care practice.
Methods: At an urban primary care pediatric office located in the southwestern US, an educational quality improvement project for healthcare practice providers and front office staff was conducted to increase the utilization of the existing EMR-linked patient portal. The healthcare providers were asked to complete a pre- and post- survey evaluation of their knowledge and usage of the patient portal. Provider and patient portal data usage was collected over a five-month period, September 2019 to January 2020.
Results: Data was analyzed using the Intellectus Statistics softwareTM. Significant results were found at the conclusion of the project in the number of active patient portal users, web-enabled, portal logins, labs published/viewed, messages sent, appointment reminders and Santovia utilization. At the end of the project no significance was found with messages received by the healthcare providers or staff through the patient portal. Survey results found significant differences between pre- and post- portal usage. No significance was found on providers’ knowledge on how to web-enable patients. Providers’ also demonstrated no significant change in their perceptions of the benefit in utilizing the portal in patient care after the educational intervention. Survey results allowed for additional analysis of commonly utilized portal functionalities, disease or health topics utilized in Santovia, and suggestions on how to make the use of the patient portal easier for providers.
Implications for Health Care Providers: This quality improvement project found that implementation an EMR-linked patient portal requires a comprehensive practice approach with structured education sessions. Including all employees can improve patient portal utilization. This educational project resulted in significant increases in most portal functionalities within 5 months. Further practice change evaluations are needed to evaluate how to improve patient portal utilization with a larger group of participants in a variety of outpatient settings.
Adolescence is a period marked by significant physical, developmental, cognitive, and social changes, all of which contribute to health concerns for teens. A steady rise in life expectancy over the past two centuries is potentially diminishing due to the increase in prevalence, severity, and consequences of obesity in children and adolescents related to unhealthy lifestyle behaviors. Health behaviors are often established during childhood and adolescence that continue into adulthood. The development and integration of healthy lifestyle behaviors are vital through adolescence. Self-determination theory (SDT) offers a theoretical framework for attempting to understand individual differences in motivation and behavior. Recent studies have primarily focused on how adolescents make choices related to eating behaviors, physical activity, and self-care habits, and how the resultant behaviors are measured. Participants in this study were 63 healthy adolescents enrolled in 9th grade health class. All participants provided baseline data at Time 1 and again following the five-week pretest posttest intervention study at Time 2. This study examined the utility of SDT in the development of the Adolescent Intrinsic Motivation, a healthy lifestyle behavior intervention, using the tenets of SDT to explain healthy lifestyle motivational beliefs in adolescents, along with healthy lifestyle behaviors and knowledge. The AIM intervention study introduced basic health recommendations to adolescents in an autonomy-supportive environment, which has been shown to encourage the adolescent to make healthy behavior choices based on their own interest and enjoyment. Preliminary effects of the study indicated that participants receiving the AIM intervention demonstrated significant differences in motivational beliefs, healthy lifestyle knowledge, as well as healthy lifestyle behaviors from Time 1 (baseline) to Time 2 (post-intervention). Results of this study provide support for the use of SDT to address the competence, relatedness, and autonomy of adolescents in the development of health education material. Testing this intervention in a larger, random sampling of schools within the state, or even in more than one state, with a three- or six-month follow-up would be useful in determining the longer-term effects of the intervention.