Lubbers Ellen R, Liebau Brandon G, Hatab Jenna M, Ream Stephen C, Mangaudis Rachael L, Khalsa Amrik Singh, Brundrett Megan E
From the Internal Medicine-Pediatrics Residency Program, Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
Department of Internal Medicine, Aultman Health System, Canton, Ohio.
Pediatr Qual Saf. 2025 Aug 8;10(5):e837. doi: 10.1097/pq9.0000000000000837. eCollection 2025 Sep-Oct.
Adolescent social media use is at an all-time high and is associated with worsening mental and physical health. The American Academy of Pediatrics advocates for social media screening and counseling, which is infrequently performed in primary care. This project aimed to increase social media screening and counseling at our internal medicine-pediatric resident clinic during adolescent well visits from 0% to 50% during 6 months and to sustain this increase for an additional 12 months.
Residents used the Model for Improvement to target the key drivers of decreased screening. Each Plan-Do-Study-Act cycle involved the implementation of interventions and the collection of data to evaluate their effectiveness. Two documentation macros were created to track screening and anticipatory guidance. The monthly chart review yielded percentages of charts with documented social media screening and anticipatory guidance.
Data were collected during 21 months. An average of 27.3 ± 3.18 charts per month met the inclusion criteria. The clinic achieved social media screening in more than 50% of 12- to 17-year-old well visits within 1 month, but it took 9 months to reach sustainability. Once reached, screening was sustained at a rate exceeding 50% for more than 12 consecutive months. Documentation of anticipatory guidance in more than 50% of visits only occurred during 2 nonconsecutive months.
We successfully implemented and sustained social media screening in more than 50% of adolescent well visits. Simple interventions made this project feasible in a multiphysician resident clinic. Barriers included a lack of documentation and macro integration into electronic note templates, as well as frequent physician turnover in a resident clinic. Anticipatory guidance documentation was below the goal but likely underreported.
青少年使用社交媒体的情况达到了前所未有的高度，且与身心健康状况恶化相关。美国儿科学会提倡进行社交媒体筛查和咨询，但在初级保健中这种做法并不常见。本项目旨在将我们内科 - 儿科住院医师诊所青少年健康检查期间的社交媒体筛查和咨询比例在6个月内从0%提高到50%，并在接下来的12个月内维持这一增长。
住院医师使用改进模型来确定筛查率降低的关键驱动因素。每个计划 - 实施 - 研究 - 改进循环都包括干预措施的实施以及收集数据以评估其有效性。创建了两个文档宏来跟踪筛查和预期指导。每月的图表审查得出记录有社交媒体筛查和预期指导的图表百分比。
在21个月内收集了数据。每月平均有27.3±3.18份图表符合纳入标准。诊所在1个月内实现了超过50%的12至17岁健康检查中有社交媒体筛查，但花了9个月才达到可持续性。一旦达到，筛查率连续超过12个月维持在50%以上。超过50%的就诊中有预期指导记录仅在两个不连续的月份出现。
我们成功地在超过50%的青少年健康检查中实施并维持了社交媒体筛查。简单的干预措施使该项目在多医生住院医师诊所中可行。障碍包括缺乏记录以及宏未集成到电子病历模板中，以及住院医师诊所中医生频繁更替。预期指导记录低于目标，但可能存在报告不足的情况。
