1 bright futures tool and resource kit 1 incorporating questionnaires into your practice edward...

1

Bright Futures Tool and Resource Kit

1


Incorporating Questionnaires into Your Practice

Edward Curry MD, FAAP

2


2


I do not have any Financial DisclosuresI do not have any Financial Disclosures

I I do notdo not intend to discuss an unapproved/investigative use intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.of a commercial product/device in my presentation.

..

EDWARD CURRY

DISCLOSURES

EDWARD CURRY

DISCLOSURES

3


3


Making the Most of the Bright Futures Guidelines

• The Guidelines provide the background and all the details.

• The question is:– How can you incorporate all that into a typical

office visit?• Use the Guidelines along with other Bright

Futures material– Previsit Questionnaires

4


4


Bright Futures Priorities

• Patient concerns and question• Physical Growth and Development• Social/academic competence• Emotional wellbeing• Risk reduction• Violence and injury prevention

5


5


Core Tools

• Previsit Questionnaires• Documentation Forms• Parent/Patient Handouts

6


6


PRIORITIES

Family support

Child development and behavior

Language promotion/hearing

Toilet training readiness

Safety

Setting the agenda

Medical Screening

8


8


Developmental Surveillance

9


9


Documenting Parental Concern

Pre-visit Questionnaire Reviewed Dental home – CSHN- BMI%

Developmental Survelliance

Bright Futures Priorities

Screening

11


11


INCORPORATING ADDITIONALINCORPORATING ADDITIONALSCREENING QUESTIONNAIRES SCREENING QUESTIONNAIRES

• MATERNAL DEPRESSION MATERNAL DEPRESSION

• AUTISM SCREENING AUTISM SCREENING

• DEVELOPMENTAL SCREENINGDEVELOPMENTAL SCREENING

• ORAL HEALTH RISK ASSESSMENTORAL HEALTH RISK ASSESSMENT

12


12


Maternal Depression: PHQ-2

13


13


Maternal Depression: PHQ-9

14


14


AUTISM CASE STUDYCHAT SCREENING

1. Does your child enjoy being swung, bounced on your knee, etc?1. Does your child enjoy being swung, bounced on your knee, etc? YESYES NONO

2. Does your child take an interest in other children?2. Does your child take an interest in other children? YESYES NONO

3. Does your child like climbing on things, such as up stairs?3. Does your child like climbing on things, such as up stairs? YESYES NONO

4. Does your child enjoy playing peek-a-boo/hide-and-seek?4. Does your child enjoy playing peek-a-boo/hide-and-seek? YESYES NONO

5. Does your child ever PRETEND, for example, to make a cup of tea using a5. Does your child ever PRETEND, for example, to make a cup of tea using a

toy cup and teapot, or pretend other things?toy cup and teapot, or pretend other things? YESYES NONO

6. Does your child ever use index finger to point, to ASK for something?6. Does your child ever use index finger to point, to ASK for something? YESYES NONO

7. Does your child ever use his/her index finger to point, to indicate 7. Does your child ever use his/her index finger to point, to indicate

INTEREST in something? INTEREST in something? YESYES NONO

8. Can your child play properly with small toys (eg. cars or bricks)8. Can your child play properly with small toys (eg. cars or bricks)

without just mouthing, fiddling or dropping them?without just mouthing, fiddling or dropping them? YESYES NONO

9. Does your child ever bring objects over to you SHOW you something?9. Does your child ever bring objects over to you SHOW you something? YESYES NONO

15


15


16


16


Questionnaires and the Electronic Health Record (EHR)

• Questionnaires can be built into EHR– Initially completed on paper – Results need to be entered manually– Provider reviews results either on paper or the computer monitor– Documentation of discussion would be placed in note.

• Ideal EHR System– Parent would complete Questionnaire Online at home– MA would review the Questionnaire for completeness on day of visit– Physician would review Questionnaire prior to entering exam room

• EHR would highlight the positive answers

17


17


ESTABLISHING A WORKFLOW !!!

18


18


WORKFLOW PREVISIT QUESTIONNAIREWORK FLOW NEED TO JOB SPECIFIC NOT PERSON SPECIFIC

• STARTS WITH INITIAL ENTRY POINT TO MEDICAL OFFICE– RECEPTIONIST PROVIDES AGE APPROPRIATE PREVISIT QUESTIONNAIRE

• PRE FORMATTED AGE SPECIFIC PACKET (18 MONTH PACKET)– 18 MONTH PREVIST QUESTIONNAIRE– CHAT OR MCHAT QUESTIONNAIRE

• PARENT WOULD COMPLETE QUESTIONNAIRE IN WAITING AREA– MEDICAL ASSISTANT ON ROOMING CHILD WOULD MAKE SURE

QUESTIONNAIRE IS COMPLETED• MA ATTACH QUESTIONNAIRE TO CHART OR ENTER THE RESULTS INTO THE

EHR

– PHYSICIAN WOULD REVIEW EITHER PAPER COPY OR EHR• WOULD DOCUMENT INTERVENTION IN CHART

– COMPLETION OF VISIT MEDICAL ASSISTANT WOULD PROVIDE APPROPRIATE PARENT HANDOUT

19


19


WORKFLOW SCREENING QUESTIONNAIREFOLLOW UP OF RED FLAG RESULTS

• MATERNAL DEPRESSION SCREENING– IF PHQ 2 DONE THEN NEED TO DO PHQ 9– IF POSITIVE THEN

• LOW RISK REFERRAL TO COMMUNITY RESOURCES• MODERATE RISK SOCIAL WORKER OR MFT • EMERGENCY MENTAL HEALTH EVALUATION

• AUTISM SCREENING

• AUTISM SCREENING– ADMINISTER MCHAT – IF POSITIVE SET FOLLOW UP PROCESS

20


20


Case Study Samantha

• Filled out all the forms

• Found out that her concerns were • Boyfriend's mother had a child with autism • Risk factor identified – new immigrants at homeless shelter – had contact

with people from Laos for three weeks

21


21


There is a family from There is a family from Laos at the homeless Laos at the homeless

shelter; child had shelter; child had been playing with been playing with

their childrentheir children

Worried about Worried about additional shots additional shots

because because boyfriend’s boyfriend’s

mother had a mother had a child with autismchild with autism

22


22


Quality Measures for Preventive ServicesAll Ages (italics indicate follow-up measure)

Parental/Patient concerns were asked about at most recent visit

Parental concerns were addressed at the most recent visit

BMI was measured and plotted on the percentile curves according to age and sex at the most recent visit

Age appropriate risk assessments were performed at the most recent visit

At-risk patients, as identified by risk assessment, with documentation in chart that risks were addressed at the most recent visit

Documentation in chart that at least one of the Bright Futures priorities was discussed/handout given a the most recent visit

Birth to 4

Oral health risk assessment by 12 months

Parental strengths were assessed at the most recent visit

Documentation of 1 completed maternal depression screen by age 6 months

Documentation of 3 completed standardized developmental screenings

% of patients with a positive developmental screen who have documentation of follow up plan in chart

Documentation of 2 completed standardized autism specific screenings

% patients with a positive autism screen who have documentation of follow up plan in chart

23


23


5 to 21 * denotes adolescence (11 to 21)

Developmental surveillance was performed at the most recent visit

Age appropriate risk behaviors were assessed at most recent visit

If risks identified, these risks were addressed

Documentation of sexual activity*

If sexually active, Chlamydia screening was performed*

System Measures

Documented system in chart to assess preventive services and risk screenings

Easily accessible organized list of community resources for parents

Identified staff person responsible for regularly updating the practice’s community resource information

System to identify and contact (ie, reminder/recall) patients who are behind schedule for preventive services

System to identify patients with special health care needs

System to track referrals using an electronic or paper based system

Additional Recognized National Well Child Measures

Well Child Visits (Frequency)

Immunizations

24


24


ReferencesHagan JF, Shaw JS, Duncan PM, eds. 2008. Bright Futures:

Guidelines for Health Supervision of Infants, Children and Adolescents, Third Edition. Elk Grove Village, IL: American Academy of Pediatrics

• Duncan,P,Shaw,J, Gottesman,MM, Swanson,JHaganJ ,Pirretti, A Bright Futures Tool and Resource Kit Elk Grove Village American Academy of Pediatrics, October 200

25


25


• The Tool and Resource Kit also contains supplementary materials:– Additional Parent/Patient Handouts– Developmental, behavioral, and psychosocial

screening and assessment tools– Practice management tools for preventive care– Information on community resources

26


26


The Bright Futures Tool and Resource Kit

• Helps you provide individualized care– Forms allow parent/patient priorities and concerns to

surface, giving you opportunities to tailor care and anticipatory guidance

• AND It helps you provide standardized care– All the forms are closely linked to Bright Futures visit

components and priorities, making clinical activities and messages consistent throughout

– Completed Documentation forms help you track care over time, ensuring that all patients receive recommended exams, screenings, and immunizations

27


27


28


28


Periodicity Schedule

1 bright futures tool and resource kit 1 incorporating questionnaires into your practice edward...

Documents

bright futures tool

bright futures guidelines

yesno slide

medical screening slide

agenda slide

faap slide

injury prevention slide

yesno toy cup