Sections of Hospital Medicine.
Medical Education.
Hosp Pediatr. 2022 Jan 1;12(1):53-61. doi: 10.1542/hpeds.2021-006038.
Hospitals are an important nontraditional setting in which to address adolescent reproductive health. However, opportunities for intervention are frequently missed, especially for boys and patients hospitalized for noningestion complaints. Our global aim was to increase delivery of reproductive health care to adolescents hospitalized through our children's hospital Pediatric Hospital Medicine service.
We performed 2 quality improvement intervention cycles: (1) provider education and monthly reminder e-mails and (2) an automated electronic health record (EHR) adolescent history and physical note template with social history prompts while discontinuing reminder e-mails. The primary outcome measure was sexual history documentation (SHD). Secondary measures were sexually transmitted infection (STI) testing and contraception provision. Statistical process control charts were used to analyze effectiveness of interventions.
From July 2018 through June 2019, 528 Primary Hospital Medicine encounters were included in this study and compared with published baseline data on 150 encounters. Control charts revealed a special cause increase in SHD from 60% to 82% overall, along with 37% to 73% for boys and 57% to 80% for noningestion hospitalizations. Increased SHD correlated with cycle 1 and was maintained through cycle 2. Percent STI testing significantly increased but did not shift or trend toward special cause variation. Contraception provision, length of stay, and patient relations consultations were not affected.
The interventions were successful in increasing SHD, including among boys and noningestion hospitalizations. The EHR enhancement maintained these increases after reminder emails were discontinued. Future interventions should specifically address STI testing and provision of contraception.
医院是解决青少年生殖健康问题的一个重要非传统场所。然而，干预的机会经常被错过，尤其是对男孩和因非摄入性疾病住院的患者。我们的总体目标是通过我们儿童医院儿科学服务增加为住院青少年提供生殖保健服务的机会。
我们进行了 2 个质量改进干预周期：（1）提供者教育和每月提醒电子邮件，以及（2）停用提醒电子邮件的同时具有社会史提示的自动电子健康记录（EHR）青少年病史和体检模板。主要结果测量指标是性史记录（SHD）。次要指标是性传播感染（STI）检测和避孕措施的提供。统计过程控制图用于分析干预措施的有效性。
从 2018 年 7 月到 2019 年 6 月，这项研究共纳入了 528 次主要医院医学就诊，并与 150 次就诊的已发表基线数据进行了比较。控制图显示，总体上 SHD 从 60%增加到 82%，男孩从 37%增加到 73%，非摄入性住院患者从 57%增加到 80%，这是一个特殊原因的增加。增加的 SHD 与第 1 周期相关，并在第 2 周期中得以维持。STI 检测的百分比显著增加，但没有发生特殊原因的变化或趋势。避孕措施的提供、住院时间和患者关系咨询没有受到影响。
这些干预措施成功地增加了 SHD，包括男孩和非摄入性住院患者。停用提醒电子邮件后，EHR 增强功能维持了这些增加。未来的干预措施应特别关注 STI 检测和避孕措施的提供。
