Let them speak for themselves: Improving adolescent self-report rate on pre-visit screening

Abstract

Background Adolescent pre-visit screening on patient-generated health data is a common and efficient practice to guide clinical decision making. However, proxy informants (e.g., parents or caregivers) often complete these forms, which may lead to incorrect information or lack of confidentiality. Our objective was to improve the adolescent self-report rate on pre-visit screening.

Methods We conducted an interventional study using an interrupted time-series design to compare adolescent self-report rates (percent of adolescents ages 12-18 years completing their own pre-visit screening) over 16 months in general pediatric ambulatory clinics. We collected data using a computerized clinical decision support system with waiting room electronic tablet screening. Pre-intervention rates were low, and we created and implemented two electronic workflow alerts, one each to the patient/caregiver and clinical staff, reminding them that the adolescent should answer the questions independently. We included the first encounter from each adolescent and evaluated changes in adolescent self-reporting between pre- and post-intervention periods using interrupted time series analysis.

Results Patients or caregivers completed 2,670 qualifying pre-visit screenings across 19 pre-intervention, 7 intervention, and 44 post-intervention weeks. Self-reporting by younger adolescents nearly doubled with a significant increase of 19.3 percentage points (CI 9.1-29.5) from the baseline 20.5%. Among older adolescents, the stable baseline rate of 53.6% increased by 9.2 absolute percentage points (CI -7.0-25.3). There were no significant pre- or post-intervention secular trends.

Conclusions Two automated alerts directing clinic personnel and families to have adolescents self-report significantly and sustainably improved younger adolescent self-reporting on electronic patient-generated health data instruments.