Broussard Camille A, Kim Julia M, Hunter Brittany, Mobley LaToya, Trent Maria, Seltzer Rebecca
From the Department of Pediatrics, Division of Adolescent and Young Adult Medicine, Johns Hopkins University School of Medicine, Baltimore, Md.
Department of Pediatrics, Division of General Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Md.
Pediatr Qual Saf. 2023 Oct 7;8(5):e699. doi: 10.1097/pq9.0000000000000699. eCollection 2023 Sep-Oct.
Children and youth in foster care (CYFC) are a population with special healthcare needs, and the American Academy of Pediatrics has healthcare standards to care for this population, but implementation challenges include identifying clinic patients in foster care (FC). Documentation of FC status in the Electronic Health Record (EHR) can support the identification of CYFC to tailor care delivery. Therefore, we aimed to improve the percentage of CYFC with problem list (PL) documentation of FC status from 20% to 60% within 12 months.
This study used a five-cycle plan-do-study-act quality improvement model in two co-located primary care teaching clinics. The primary outcome was the weekly percentage of patients with FC status on EHR PL. Ishikawa cause and effect analysis and resident survey identified barriers and informed interventions: education, patient list distribution, documentation training, email reminders, and clinic champion. We constructed statistical process control charts of the primary outcome to assess for improvement.
Mean weekly percentage of patients with FC status on PL improved from 19.8% to 60.2%. The most extensive improvements occurred after designating a clinic champion and providing email reminders with enhanced patient lists. The sustainability of PL documentation (mean = 71.7%) was demonstrated 3-4 years after the completion of plan-do-study-act cycle interventions.
Educating providers, collaborating with child welfare to provide patient lists to providers, standardizing documentation, and designating clinic champions are promising methods of improving EHR documentation of FC status. Identifying and documenting FC status are important initial steps to optimizing care for this vulnerable population in primary care.
寄养儿童和青少年（CYFC）是有特殊医疗需求的人群，美国儿科学会有针对该人群的医疗标准，但实施方面的挑战包括识别寄养机构（FC）中的门诊患者。电子健康记录（EHR）中FC状态的记录有助于识别CYFC，以调整护理服务。因此，我们旨在在12个月内将有FC状态问题列表（PL）记录的CYFC比例从20%提高到60%。
本研究在两个同地的初级保健教学诊所采用了五周期的计划-执行-研究-行动质量改进模型。主要结果是EHR PL上有FC状态的患者的每周百分比。石川因果分析和住院医师调查确定了障碍并为干预措施提供了依据：教育、患者名单分发、记录培训、电子邮件提醒和诊所负责人。我们构建了主要结果的统计过程控制图以评估改进情况。
PL上有FC状态的患者的平均每周百分比从19.8%提高到了60.2%。在指定诊所负责人并提供带有增强患者名单的电子邮件提醒后，取得了最显著的改进。在计划-执行-研究-行动周期干预完成3至4年后，证明了PL记录的可持续性（平均=71.7%）。
对医疗服务提供者进行教育、与儿童福利机构合作向医疗服务提供者提供患者名单、规范记录以及指定诊所负责人是改善FC状态EHR记录的有效方法。识别和记录FC状态是在初级保健中优化对这一弱势群体护理的重要初始步骤。
