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REQUEST, RECORD, AND REPORT: A QUALITY IMPROVEMENT EFFORT TO IMPROVE PATIENT NOTIFICATION AND TREATMENT OF STIS IN A RESIDENT CLINIC

Purpose: In most states, minors have the right to consent to testing and treatment of sexually transmitted infections (STI) without parental consent. Many electronic medical record systems capture parent phone numbers, but not those of the teen. We observed a disparity in our institution regarding t...

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Published in:Journal of adolescent health 2019-02, Vol.64 (2S), p.S135
Main Authors: Davidson, Asha, Barratt, Michelle, Furbacher, Jacqueline, Beyda, Rebecca
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Barratt, Michelle
Furbacher, Jacqueline
Beyda, Rebecca
description Purpose: In most states, minors have the right to consent to testing and treatment of sexually transmitted infections (STI) without parental consent. Many electronic medical record systems capture parent phone numbers, but not those of the teen. We observed a disparity in our institution regarding the timeliness and consistency of STI notification and treatment for adolescent patients seen in our resident clinics. Notification was often complicated by inconsistent documentation of a confidential teen phone number, or alternatively, permission to notify the teen's parent. The aim of this project was to assess whether modifying the EMR would enhance physician documentation of pertinent contact information and improve the time to notification of positive STI results and treatment at our clinics. Methods: We conducted a retrospective chart review in a large, urban resident clinic from July 2013 - June 2016. A quality improvement (QI) initiative included modification of the clinic's electronic medical record (EMR) and training of faculty and residents. A confidential section was added to the existing adolescent note template in the EMR that addressed four questions related to STI notification. The questions included documentation of a confidential phone number, the preferred time to contact the teen, permission to notify a parent or guardian, and permission to leave a voicemail The QI intervention with EMR modification and training took place July 1, 2015. For analysis, the patients were divided into two groups: Pre QI and Post QI. One year of data was included in each group. Outcomes measures included the following: time to notification of any GC/CT result, time to notification of a positive GC/CT result, and percent documentation of the four questions in EMR. The institutional review board deemed this a quality improvement project. Results: We reviewed 157 charts to date: 108 Pre QI and 49 Post QI. The two groups were similar in demographics with 78% female Pre and 70% Post QI, average age 16.4 years (SD 2.7 years)Pre and average age 16.1 years (SD 1.6 years) PostQI. The sexually transmitted infections recorded included gonorrhea (GC), chlamydia (CT), or both. 15 patients (13.9%) tested positive to any STI in the Pre QI group. 5 patients (10.2%) tested positive to any STI in the Post QI group. The time to notify and treat patients Pre QI was 8.5 days (SD 12.7 days) versus 2.6 days (SD 1.7 days) Post QI (p value = 0.16). Additional analysis of the EMR question
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Many electronic medical record systems capture parent phone numbers, but not those of the teen. We observed a disparity in our institution regarding the timeliness and consistency of STI notification and treatment for adolescent patients seen in our resident clinics. Notification was often complicated by inconsistent documentation of a confidential teen phone number, or alternatively, permission to notify the teen's parent. The aim of this project was to assess whether modifying the EMR would enhance physician documentation of pertinent contact information and improve the time to notification of positive STI results and treatment at our clinics. Methods: We conducted a retrospective chart review in a large, urban resident clinic from July 2013 - June 2016. A quality improvement (QI) initiative included modification of the clinic's electronic medical record (EMR) and training of faculty and residents. A confidential section was added to the existing adolescent note template in the EMR that addressed four questions related to STI notification. The questions included documentation of a confidential phone number, the preferred time to contact the teen, permission to notify a parent or guardian, and permission to leave a voicemail The QI intervention with EMR modification and training took place July 1, 2015. For analysis, the patients were divided into two groups: Pre QI and Post QI. One year of data was included in each group. Outcomes measures included the following: time to notification of any GC/CT result, time to notification of a positive GC/CT result, and percent documentation of the four questions in EMR. The institutional review board deemed this a quality improvement project. Results: We reviewed 157 charts to date: 108 Pre QI and 49 Post QI. The two groups were similar in demographics with 78% female Pre and 70% Post QI, average age 16.4 years (SD 2.7 years)Pre and average age 16.1 years (SD 1.6 years) PostQI. The sexually transmitted infections recorded included gonorrhea (GC), chlamydia (CT), or both. 15 patients (13.9%) tested positive to any STI in the Pre QI group. 5 patients (10.2%) tested positive to any STI in the Post QI group. The time to notify and treat patients Pre QI was 8.5 days (SD 12.7 days) versus 2.6 days (SD 1.7 days) Post QI (p value = 0.16). Additional analysis of the EMR questions found 37% of the Post QI providers had documented a confidential phone number, 27% of patients were OK with notifying parents of positive results, 10% provided a preferred time to call, and 16% of patients gave permission to leave a voicemail. Conclusions: Modification of the EMR to include a confidential phone number may improve the time to notification and treatment of STIs in a resident clinic. Interestingly, 27% of our patients were OK with parents being notified of results which may be another way to reach teens and treat infections in a more timely manner.</description><identifier>ISSN: 1054-139X</identifier><identifier>EISSN: 1879-1972</identifier><language>eng</language><publisher>New York: Elsevier BV</publisher><subject>Adolescents ; Answering machines ; Chart reviews ; Chlamydia trachomatis ; Clinics ; Consent ; Gonorrhea ; Medical education ; Medical treatment ; Notification ; Permission ; Quality control ; Quality improvement ; Quality management ; Review boards ; Sexually transmitted diseases ; STD ; Teenagers</subject><ispartof>Journal of adolescent health, 2019-02, Vol.64 (2S), p.S135</ispartof><rights>Copyright Elsevier BV Feb 2019</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,30997</link.rule.ids></links><search><creatorcontrib>Davidson, Asha</creatorcontrib><creatorcontrib>Barratt, Michelle</creatorcontrib><creatorcontrib>Furbacher, Jacqueline</creatorcontrib><creatorcontrib>Beyda, Rebecca</creatorcontrib><title>REQUEST, RECORD, AND REPORT: A QUALITY IMPROVEMENT EFFORT TO IMPROVE PATIENT NOTIFICATION AND TREATMENT OF STIS IN A RESIDENT CLINIC</title><title>Journal of adolescent health</title><description>Purpose: In most states, minors have the right to consent to testing and treatment of sexually transmitted infections (STI) without parental consent. Many electronic medical record systems capture parent phone numbers, but not those of the teen. We observed a disparity in our institution regarding the timeliness and consistency of STI notification and treatment for adolescent patients seen in our resident clinics. Notification was often complicated by inconsistent documentation of a confidential teen phone number, or alternatively, permission to notify the teen's parent. The aim of this project was to assess whether modifying the EMR would enhance physician documentation of pertinent contact information and improve the time to notification of positive STI results and treatment at our clinics. Methods: We conducted a retrospective chart review in a large, urban resident clinic from July 2013 - June 2016. A quality improvement (QI) initiative included modification of the clinic's electronic medical record (EMR) and training of faculty and residents. A confidential section was added to the existing adolescent note template in the EMR that addressed four questions related to STI notification. The questions included documentation of a confidential phone number, the preferred time to contact the teen, permission to notify a parent or guardian, and permission to leave a voicemail The QI intervention with EMR modification and training took place July 1, 2015. For analysis, the patients were divided into two groups: Pre QI and Post QI. One year of data was included in each group. Outcomes measures included the following: time to notification of any GC/CT result, time to notification of a positive GC/CT result, and percent documentation of the four questions in EMR. The institutional review board deemed this a quality improvement project. Results: We reviewed 157 charts to date: 108 Pre QI and 49 Post QI. The two groups were similar in demographics with 78% female Pre and 70% Post QI, average age 16.4 years (SD 2.7 years)Pre and average age 16.1 years (SD 1.6 years) PostQI. The sexually transmitted infections recorded included gonorrhea (GC), chlamydia (CT), or both. 15 patients (13.9%) tested positive to any STI in the Pre QI group. 5 patients (10.2%) tested positive to any STI in the Post QI group. The time to notify and treat patients Pre QI was 8.5 days (SD 12.7 days) versus 2.6 days (SD 1.7 days) Post QI (p value = 0.16). Additional analysis of the EMR questions found 37% of the Post QI providers had documented a confidential phone number, 27% of patients were OK with notifying parents of positive results, 10% provided a preferred time to call, and 16% of patients gave permission to leave a voicemail. Conclusions: Modification of the EMR to include a confidential phone number may improve the time to notification and treatment of STIs in a resident clinic. 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Many electronic medical record systems capture parent phone numbers, but not those of the teen. We observed a disparity in our institution regarding the timeliness and consistency of STI notification and treatment for adolescent patients seen in our resident clinics. Notification was often complicated by inconsistent documentation of a confidential teen phone number, or alternatively, permission to notify the teen's parent. The aim of this project was to assess whether modifying the EMR would enhance physician documentation of pertinent contact information and improve the time to notification of positive STI results and treatment at our clinics. Methods: We conducted a retrospective chart review in a large, urban resident clinic from July 2013 - June 2016. A quality improvement (QI) initiative included modification of the clinic's electronic medical record (EMR) and training of faculty and residents. A confidential section was added to the existing adolescent note template in the EMR that addressed four questions related to STI notification. The questions included documentation of a confidential phone number, the preferred time to contact the teen, permission to notify a parent or guardian, and permission to leave a voicemail The QI intervention with EMR modification and training took place July 1, 2015. For analysis, the patients were divided into two groups: Pre QI and Post QI. One year of data was included in each group. Outcomes measures included the following: time to notification of any GC/CT result, time to notification of a positive GC/CT result, and percent documentation of the four questions in EMR. The institutional review board deemed this a quality improvement project. Results: We reviewed 157 charts to date: 108 Pre QI and 49 Post QI. The two groups were similar in demographics with 78% female Pre and 70% Post QI, average age 16.4 years (SD 2.7 years)Pre and average age 16.1 years (SD 1.6 years) PostQI. The sexually transmitted infections recorded included gonorrhea (GC), chlamydia (CT), or both. 15 patients (13.9%) tested positive to any STI in the Pre QI group. 5 patients (10.2%) tested positive to any STI in the Post QI group. The time to notify and treat patients Pre QI was 8.5 days (SD 12.7 days) versus 2.6 days (SD 1.7 days) Post QI (p value = 0.16). Additional analysis of the EMR questions found 37% of the Post QI providers had documented a confidential phone number, 27% of patients were OK with notifying parents of positive results, 10% provided a preferred time to call, and 16% of patients gave permission to leave a voicemail. Conclusions: Modification of the EMR to include a confidential phone number may improve the time to notification and treatment of STIs in a resident clinic. Interestingly, 27% of our patients were OK with parents being notified of results which may be another way to reach teens and treat infections in a more timely manner.</abstract><cop>New York</cop><pub>Elsevier BV</pub></addata></record>
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source Applied Social Sciences Index & Abstracts (ASSIA); ScienceDirect Freedom Collection
subjects Adolescents
Answering machines
Chart reviews
Chlamydia trachomatis
Clinics
Consent
Gonorrhea
Medical education
Medical treatment
Notification
Permission
Quality control
Quality improvement
Quality management
Review boards
Sexually transmitted diseases
STD
Teenagers
title REQUEST, RECORD, AND REPORT: A QUALITY IMPROVEMENT EFFORT TO IMPROVE PATIENT NOTIFICATION AND TREATMENT OF STIS IN A RESIDENT CLINIC
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