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Age Appropriate Risk Assessment

Age Appropriate Risk Assessment. Bill Stratbucker, MD, MS, FAAP Preventive Services Improvement Project September 2011. Objectives. Familiarize yourself with the benefits of Age Appropriate Risk Assessments Share examples of risk assessment tools Explore implementation strategies.

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Age Appropriate Risk Assessment

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  1. Age Appropriate Risk Assessment Bill Stratbucker, MD, MS, FAAP Preventive Services Improvement Project September 2011

  2. Objectives • Familiarize yourself with the benefits of Age Appropriate Risk Assessments • Share examples of risk assessment tools • Explore implementation strategies

  3. Periodicity Schedule

  4. Benefits of the Risk Assessment • Standardization of preventive care • Increased reliability of thoroughness at each visit • Stratified approach based on patient’s risk

  5. PreSIP goal • “100% of pratices have a documented system in chart to assess preventive services and risk screenings”

  6. Risk Assessment Tools • Age-specific tools • Condition-specific tools • Previsit Questionnaire • Preventive Services Prompting Sheet

  7. Age-specific tools • 9-month well child risk assessment • 24-month well child risk assessment

  8. Screening table – 9 month visit

  9. Risk assessment questions – 9 months

  10. Screening table – 2 year visit

  11. Risk assessment questions – 24 months

  12. Condition-specific tools • Examples • Eliciting Parental Concerns • BMI and weight-for-length • Oral Health • Developmental • Autism • Parental Depression • Eliciting Parental Strengths

  13. Eliciting Parent Concerns • Drives the visit discussion and, sometimes, decision making • Highest priority • Asked by questionnaire, staff, physician • Asked within specific risk assessments • Vision • Hearing

  14. Visit Priorities – 18 months

  15. Weight-for-length and BMI • Plot weight-for-length under 2 on WHO growth chart • BMI starting at the 2-year well visit on CDC growth chart • Documentation of %ile in well visit note • Conditionality (if this, then…) • Specific counseling, labs, follow-up visit, etc.

  16. Depression screening • Who do you screen? • Mother, father, guardian, grandparent • When do you screen? • Which visit(s), timing within visit • How do you screen? • Which tool, back-up tool? • When do you refer? • Diagnostic evaluation? Treat?

  17. Implementation • How do we ask all these questions about risk? • How do we remember if we’ve asked the questions or completed age-appropriate screening/services/referral? • How do we incorporate patient designations? (CSHCN, Down Syndrome, hearing loss risk, etc.)

  18. How do we ask all these questions? • Incorporate into well visit template (paper or EHR) • Use previsit questionnaire • Provide screening tools to parent for completion (ASQ, MCHAT)

  19. Implementation Strategies • Previsit questionnaire • Paper, e-survey in health portal, kiosk, tablet, staff-directed, physician-directed • Literacy concerns • Time concerns • Author concerns (who is filling it out?, confidentiality) • EHR concerns (scanning, inputting data, data retrieval)

  20. Implementation Strategies • How do we remember if we’ve asked the questions or completed age-appropriate screening/services/referral?

  21. Preventive Services Prompting Sheet

  22. PSPS • Practice management resource • Facilitates communication across providers • Helps to distribute work across team • Allows anyone to quickly assess whether up-to-date • Identifies those in need of preventive services • Prompts team member to provide at any visit

  23. Patient Designations • How do we incorporate patient designations? (CSHCN, Down Syndrome, hearing loss risk, etc.) • Enter into section on PVPS or integrate into EHR so defaults to appropriate growth chart and condition-specific periodicity

  24. Preventive Services Prompting Sheet

  25. Incorporating into EHR • When well visit scheduled, auto-prompts the correct age template • 90/10 rule for defaults • No click defaults • PSPS becomes “to do” list or “not done” list • Screening questions can be built into ROS but need scoring system

  26. Incorporating into EHR • Conditionality very important, (if this, then ?) • Standard, Routine or Alternate ordering prompts • Color codes can be tool to recognize overdue service • Query for reminder recalls • Add specialized periodicity based on risk, condition, insurance type

  27. Incorporating into EHR • Itemization important for getting data back out of EHR for study, QI • Need to decide what level of detail gets a specific response (yes/no, drop down choice) vs. “text blob”

  28. Periodicity Schedule

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