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This session aims to familiarize healthcare providers with the benefits of implementing age-appropriate risk assessments. Attendees will explore various risk assessment tools tailored for different age groups, learn effective implementation strategies, and understand the importance of standardizing preventive care. The session will cover structured approaches based on patient risk, including the use of pre-visit questionnaires and condition-specific assessment tools. By enhancing reliability and thoroughness at each visit, practices can ensure they meet the goal of 100% documentation for preventive services and risk screenings.
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Age Appropriate Risk Assessment Bill Stratbucker, MD, MS, FAAPEd Curry, MD, FAAP Preventive Services Improvement Project Learning Session January 21-22, 2011
Objectives • Familiarize yourself with the benefits of Age Appropriate Risk Assessments • Share examples of risk assessment tools • Explore implementation strategies
Benefits of the Risk Assessment • Standardization of preventive care • Increased reliability of thoroughness at each visit • Stratified approach based on patient’s risk
PreSIP goal • “100% of pratices have a documented system in chart to assess preventive services and risk screenings”
Risk Assessment Tools • Age-specific tools • Condition-specific tools • Previsit Questionnaire • Preventive Services Prompting Sheet
Age-specific tools • 9-month well child risk assessment • 24-month well child risk assessment
Condition-specific tools • Examples • Eliciting Parental Concerns • BMI and weight-for-length • Oral Health • Developmental • Autism • Parental Depression • Eliciting Parental Strengths
Eliciting Parent Concerns • Drives the visit discussion and, sometimes, decision making • Highest priority • Asked by questionnaire, staff, physician • Asked within specific risk assessments • Vision • Hearing
Weight-for-length and BMI • Plot weight-for-length under 2 on WHO growth chart • BMI starting at the 2-year well visit on CDC growth chart • Documentation of %ile in well visit note • Conditionality (if this, then…) • Specific counseling, labs, follow-up visit, etc.
Depression screening • Who do you screen? • Mother, father, guardian, grandparent • When do you screen? • Which visit(s), timing within visit • How do you screen? • Which tool, back-up tool? • When do you refer? • Diagnostic evaluation? Treat?
Implementation • How do we ask all these questions about risk? • How do we remember if we’ve asked the questions or completed age-appropriate screening/services/referral? • How do we incorporate patient designations? (CSHCN, Down Syndrome, hearing loss risk, etc.)
How do we ask all these questions? • Incorporate into well visit template (paper or EHR) • Use previsit questionnaire • Provide screening tools to parent for completion (ASQ, MCHAT)
Implementation Strategies • Previsit questionnaire • Paper, e-survey in health portal, kiosk, tablet, staff-directed, physician-directed • Literacy concerns • Time concerns • Author concerns (who is filling it out?, confidentiality) • EHR concerns (scanning, inputting data, data retrieval)
Implementation Strategies • How do we remember if we’ve asked the questions or completed age-appropriate screening/services/referral?
PSPS • Practice management resource • Facilitates communication across providers • Helps to distribute work across team • Allows anyone to quickly assess whether up-to-date • Identifies those in need of preventive services • Prompts team member to provide at any visit
Patient Designations • How do we incorporate patient designations? (CSHCN, Down Syndrome, hearing loss risk, etc.) • Enter into section on PVPS or integrate into EHR so defaults to appropriate growth chart and condition-specific periodicity
Incorporating into EHR • When well visit scheduled, auto-prompts the correct age template • 90/10 rule for defaults • No click defaults • PSPS becomes “to do” list or “not done” list • Screening questions can be built into ROS but need scoring system
Incorporating into EHR • Conditionality very important, (if this, then ?) • Standard, Routine or Alternate ordering prompts • Color codes can be tool to recognize overdue service • Query for reminder recalls • Add specialized periodicity based on risk, condition, insurance type
Incorporating into EHR • Itemization important for getting data back out of EHR for study, QI • Need to decide what level of detail gets a specific response (yes/no, drop down choice) vs. “text blob”
Kaiser Permanente ExampleED CURRY PROACTIVE OFFICE ENCOUNTER • WORKSHEET WITH MISSING CARE GAPS • RELATED TO THE AGE OF THE CHILD PREVISIT QUESTIONNAIRE • BUILT IN SCREENING QUESTIONS • DECREASE THE USE OF MULTIPLE SHEETS OF QUESTIONNAIRES • LESS IS BETTER
BRIGHT FUTURE RESEARCHHEARING AND VISION QUESTIONNAIRE VALIDATION STUDY • B.F. HEARING AND VISION QUESTIONNAIRE COMPLETED AT 11 TO 18 YEARS HEALTH SUPERVISION VISIT • QUESTIONNAIRE RESPONSES WERE COMPARED TO ACTUAL HEARING AND VISION RESULTS.
