Significance
Introduction
Methods
Methods Overview
Phase I Methods: Gathering Stakeholder Perspectives
Adolescent, Provider and Staff Recruitment
Practice and Physician Surveys
Phase II Methods: Design and Implementation of HIT-Enhanced HRA
Intervention Design
Implementation: Adolescent Recruitment
Phase III Methods: Patient Reported Outcomes
Patient Reported Outcomes: Adolescent Recruitment
Patient Reported Outcomes: Analysis
Results
Phase I | |||
---|---|---|---|
Adolescent focus groups (N = 35) | Provider and staff focus groups (N = 65) | Provider surveys (N = 80) | Practice demographic surveys (N = 22) |
8 Focus groups | 9 Focus groups | Paper/online surveys | Paper/online surveys |
HRAs should be conducted in professional, clinical settings HIT-enhancement would promote honesty and confidentiality Must not replace face-to-face counseling on risk-taking behaviors (enhances conversations with providers) |
Barriers to HRAs
Time to administer, review Lack of knowledge about health resources Privacy/confidentiality
Facilitators to HRAs
Reducing time spent Long-term provider-patient relationships HIT, culturally competent tool, access to health resources |
Low levels of
Routine GAPS administration Routine depression screening
High levels of
Discussing confidentiality Asking about common risk behaviors Referrals were highest for nutrition and exercise needs and substance use, and relatively low for tobacco and alcohol use and sexual health issues | 4 FQHCs, 6 private practices, 2 affiliated with private hospitals, and 10 affiliated with academic health centers 66.7 % already implemented an EHR Even distribution of adolescent patients |
Phase II | |
---|---|
Practices (N = 22); adolescents (N = 609) | Adolescents (N = 200) answered telephone surveys (YAHCS) |
Feasibility of HIT-enhanced HRA
Adolescent patients per clinics
Mean = 28 Median = 20 Range = 1–116 Participation rate (#enrolled/#eligible ×100 %) 13.9–100 % Implementation supports feasibility of intervention | 163 adolescents included in data analysis (exclusions for “other” race) 2 of 8 domains showed intervention adolescents received significantly higher counseling (1.0 represents perfect report of counseling) 1. Receipt of private and confidential care (0.42 vs 0.08 out of 1.0, p < .01) 2. Counseling related to depression, mental health, emotions and relationships (0.85 vs 0.57 out of 1.0, p < .01) |
Phase I Results: Stakeholder Perspectives
Adolescent Focus Groups
Provider and Staff Focus Groups
Provider and Practice Surveys
Phase II Results: Feasibility of HIT-Enhanced Adolescent HRA
HRA: Adolescent Recruitment Results
Phase III Results: Patient Reported Outcomes and Experiences of Care
Intervention group n = 99 (%) | Comparison group n = 64 (%) | Total n = 163 (%) | |
---|---|---|---|
Patient-level characteristics
| |||
Gender | |||
Male | 45.5 | 34.4 | 41.1 |
Female | 54.5 | 65.6 | 58.9 |
Age in years | |||
14 | 26.3 | 12.5 | 20.9 |
15 | 20.2 | 21.9 | 20.9 |
16 | 21.2 | 20.3 | 20.9 |
17 | 14.1 | 26.6 | 19.0 |
18 + years | 18.2 | 17.2 | 18.4 |
Race/ethnicity | |||
White, non-Hispanic | 47.5 | 50.0 | 48.5 |
Black, non-Hispanic | 46.5 | 25.0 | 38.0 |
Hispanic | 6.1 | 25.0 | 13.5 |
Self-reported Risk Behaviors | |||
Smoked in past 30 days | 0.0 | 3.1 | 1.2 |
Smoked in past 12 months | 4.0 | 4.7 | 4.3 |
Had at least one drink of alcohol in past 30 days | 8.1 | 11.1 | 9.3 |
Had 5 + drinks in a row in the past 30 daysa
| 12.5 | 50.0 | 31.2 |
Ever had sexual intercourse | 18.2 | 27.0 | 21.6 |
Did not use a condom at last sexual intercoursea
| 38.9 | 11.8 | 25.7 |
Sad or hopeless almost every day for two weeks | 14.3 | 20.3 | 16.7 |
Clinic-specific Information (n = 13) | Intervention group n = 11 (%) | Comparison group n = 2 (%) |
---|---|---|
What % of the patients at your clinic are enrolled in medicaid or CHIP? | ||
Less than 10 % | 22.2 | 50.0 |
10–24 % | 11.1 | 0.0 |
25–50 % | 11.1 | 0.0 |
More than 50 % | 55.6 | 50.0 |
What % of the patients at your clinic are between 14 and 18 years old? | ||
Less than 10 % | 11.1 | 0.0 |
10–24 % | 44.4 | 0.0 |
25–50 % | 33.3 | 100.0 |
More than 50 % | 11.1 | 0.0 |
Clinic (weighted —N is the number of respondents = 163)
| ||
What % of the patients at your clinic are enrolled in medicaid or CHIP? | ||
Less than 10 % | 14.1 | 82.8 |
10–24 % | 22.2 | 0.0 |
25–50 % | 3.0 | 0.0 |
More than 50 % | 60.6 | 17.2 |
What % of the patients at your clinic are between 14 and 18 years old? | ||
Less than 10 % | 5.1 | 0.0 |
10–24 % | 48.5 | 0.0 |
25–50 % | 36.4 | 100.0 |
More than 50 % | 10.1 | 0.0 |
Risky behaviors | Sexual activity and STDs | Weight, diet and exercise | Emotions and relationships | Private and confidential | Counseling helpfulness | Communication and experience of Care | Health information | |||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Group | Mean scorea
| SE | Mean scorea
| SE | Mean scorea
| SE | Mean scorea
| SE | Mean scorea
| SE | Mean scorea
| SE | Mean scorea
| SE | Mean scorea
| SE |
Intervention (adjusted) | 0.36 | 0.06 | 0.43 | 0.07 | 0.65 | 0.05 |
0.42
|
0.05
|
0.85
|
0.04
| 0.69 | 0.05 | 0.52 | 0.01 | 0.64 | 0.06 |
Control (adjusted) | 0.05 | 0.11 | 0.22 | 0.13 | 0.51 | 0.04 |
0.08
|
0.09
|
0.57
|
0.03
| 0.75 | 0.06 | 0.51 | 0.01 | 0.37 | 0.12 |
p value | 0.03 | 0.17 | 0.05 | <0.01
| <0.0001
| 0.39 | 0.51 | 0.07 | ||||||||
Gender | ||||||||||||||||
Female | 0.17 | 0.06 | 0.33 | 0.08 | 0.60 | 0.04 | 0.28 | 0.05 | 0.71 | 0.03 |
0.84
|
0.05
| 0.52 | 0.01 | 0.54 | 0.07 |
Male | 0.24 | 0.07 | 0.33 | 0.08 | 0.55 | 0.05 | 0.23 | 0.06 | 0.72 | 0.04 |
0.61
|
0.05
| 0.51 | 0.01 | 0.47 | 0.08 |
p value | 0.04 | 0.86 | 0.45 | 0.86 | 0.49 | <0.01
| 0.49 | 0.66 | ||||||||
Race/Ethnicity | ||||||||||||||||
Black/African-American | 0.27 | 0.07 | 0.35 | 0.08 | 0.55 | 0.04 | 0.30 | 0.06 | 0.72 | 0.03 | 0.67 | 0.04 | 0.51 | 0.01 | 0.56 | 0.07 |
Hispanic/Latino | 0.22 | 0.07 | 0.38 | 0.08 | 0.64 | 0.05 | 0.29 | 0.06 | 0.70 | 0.04 | 0.70 | 0.05 | 0.52 | 0.01 | 0.55 | 0.08 |
White | 0.12 | 0.09 | 0.25 | 0.10 | 0.54 | 0.08 | 0.16 | 0.08 | 0.71 | 0.06 | 0.79 | 0.10 | 0.51 | 0.01 | 0.41 | 0.10 |
p value | 0.03 | 0.16 | 0.12 | 0.02 | 0.26 | 0.42 | 0.71 | 0.05 | ||||||||
Age | ||||||||||||||||
p value | 0.16 | 0.41 | 0.45 | 0.62 | 0.51 | 0.33 | 0.67 | 0.35 |