The Vermont Child Health Improvement Program, Department of Pediatrics, College of Medicine, University of Vermont, Burlington, Vermont 05401, USA.
Pediatrics. 2012 Nov;130(5):e1345-51. doi: 10.1542/peds.2011-2356. Epub 2012 Oct 1.
High-quality preventive services for youth aged 11 to 18 include assessment and counseling regarding health behavior risks and developmental tasks/strengths of adolescence. Nationally, primary care health behavior risk screening and counseling rates lag considerably behind other preventive health services. The purpose of this project was to assist pediatric and family medicine practices to make office systems-based changes that promote comprehensive screening and counseling for risks and developmental tasks/strengths during adolescent preventive services visits.
Over a 9-month period, 7 pediatric and 1 family medicine primary care practices (13 physicians and 3 nurse practitioners) participated in a modified Breakthrough Series Collaborative. This project was designed to support primary care practitioner efforts to implement comprehensive screening and counseling for risk behaviors and developmental tasks/strengths for their adolescent patients and increase the rate of brief office intervention and referral. Composite variables were designed to reflect whether screening and counseling were documented for risks and developmental tasks. Statistical comparisons were made by using the nonparametric Wilcoxon matched-pairs signed rank test.
There were increases in the composite measures of screening and counseling for risk behaviors (all 6 risks: 26%-50%, P = .01) and 3 of 4 developmental tasks/strengths (32%-66%, P = .01). Documentation of office interventions for identified risks and out-of office referral rates did not change.
With the use of an office systems-based approach, screening and counseling for all critical risk behaviors and developmental tasks/strengths during adolescent preventive services visits can be improved in primary care practices.
为 11 至 18 岁的青少年提供高质量的预防服务包括评估和咨询健康行为风险和青春期的发展任务/优势。在全国范围内，初级保健健康行为风险筛查和咨询率远远落后于其他预防保健服务。本项目旨在帮助儿科和家庭医学实践进行基于办公室系统的改变，以促进在青少年预防保健就诊期间进行全面的风险筛查和咨询。
在 9 个月的时间里，7 家儿科和 1 家家庭医学初级保健实践（13 名医生和 3 名护士从业者）参加了改进的突破系列合作。该项目旨在支持初级保健从业者努力为青少年患者实施全面的风险行为筛查和咨询，并增加简短的办公室干预和转诊的比率。综合变量的设计旨在反映是否记录了风险和发展任务的筛查和咨询。使用非参数 Wilcoxon 匹配对符号秩检验进行了统计比较。
风险行为的筛查和咨询综合指标有所增加（所有 6 种风险：26%-50%，P =.01），4 种发展任务/优势中的 3 种（32%-66%，P =.01）。识别出的风险的办公室干预措施和外出转诊率的文件记录没有变化。
通过使用基于办公室系统的方法，可以在初级保健实践中改善青少年预防保健就诊期间所有关键风险行为和发展任务/优势的筛查和咨询。
