1 bright futures tool and resource kit 1 incorporating questionnaires into your practice edward...
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Bright Futures Tool and Resource Kit
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Bright Futures Tool and Resource Kit
Incorporating Questionnaires into Your Practice
Edward Curry MD, FAAP
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Bright Futures Tool and Resource Kit
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Bright Futures Tool and Resource Kit
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
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Bright Futures Tool and Resource Kit
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Bright Futures Tool and Resource Kit
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
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Bright Futures Tool and Resource Kit
Bright Futures Priorities
• Patient concerns and question• Physical Growth and Development• Social/academic competence• Emotional wellbeing• Risk reduction• Violence and injury prevention
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Bright Futures Tool and Resource Kit
Core Tools
• Previsit Questionnaires• Documentation Forms• Parent/Patient Handouts
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Bright Futures Tool and Resource Kit
PRIORITIES
Family support
Child development and behavior
Language promotion/hearing
Toilet training readiness
Safety
Setting the agenda
Medical Screening
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Bright Futures Tool and Resource Kit
Developmental Surveillance
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Bright Futures Tool and Resource Kit
Documenting Parental Concern
Pre-visit Questionnaire Reviewed Dental home – CSHN- BMI%
Developmental Survelliance
Bright Futures Priorities
Screening
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Bright Futures Tool and Resource Kit
INCORPORATING ADDITIONALINCORPORATING ADDITIONALSCREENING QUESTIONNAIRES SCREENING QUESTIONNAIRES
• MATERNAL DEPRESSION MATERNAL DEPRESSION
• AUTISM SCREENING AUTISM SCREENING
• DEVELOPMENTAL SCREENINGDEVELOPMENTAL SCREENING
• ORAL HEALTH RISK ASSESSMENTORAL HEALTH RISK ASSESSMENT
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Bright Futures Tool and Resource Kit
Maternal Depression: PHQ-2
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Bright Futures Tool and Resource Kit
Maternal Depression: PHQ-9
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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
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Bright Futures Tool and Resource Kit
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
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Bright Futures Tool and Resource Kit
ESTABLISHING A WORKFLOW !!!
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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
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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
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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
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Bright Futures Tool and Resource Kit
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
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Bright Futures Tool and Resource Kit
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
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Bright Futures Tool and Resource Kit
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
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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
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Bright Futures Tool and Resource Kit
• 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
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Bright Futures Tool and Resource Kit
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
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Periodicity Schedule
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