1 Bright Futures Tool and Resource Kit 1 Incorporating Questionnaires into Your Practice Edward Curry MD, FAAP

2 Bright Futures Tool and Resource Kit 2 I do not have any Financial Disclosures I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.. EDWARD CURRY DISCLOSURES

3 Bright Futures Tool and Resource Kit 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 Bright Futures Tool and Resource Kit 4 Bright Futures Priorities Patient concerns and question Physical Growth and Development Social/academic competence Emotional wellbeing Risk reduction Violence and injury prevention

5 Bright Futures Tool and Resource Kit 5 Core Tools Previsit Questionnaires Documentation Forms Parent/Patient Handouts

6 Bright Futures Tool and Resource Kit 6 PRIORITIES Family support Child development and behavior Language promotion/hearing Toilet training readiness Safety Setting the agenda

Medical Screening

8 Bright Futures Tool and Resource Kit 8 Developmental Surveillance

9 Bright Futures Tool and Resource Kit 9 Documenting Parental Concern Pre-visit Questionnaire Reviewed Dental home – CSHN- BMI% Developmental Survelliance Bright Futures Priorities Screening

11 Bright Futures Tool and Resource Kit 11 Bright Futures Tool and Resource Kit INCORPORATING ADDITIONAL SCREENING QUESTIONNAIRES INCORPORATING ADDITIONAL SCREENING QUESTIONNAIRES MATERNAL DEPRESSION MATERNAL DEPRESSION AUTISM SCREENING AUTISM SCREENING DEVELOPMENTAL SCREENINGDEVELOPMENTAL SCREENING ORAL HEALTH RISK ASSESSMENTORAL HEALTH RISK ASSESSMENT

12 Bright Futures Tool and Resource Kit 12 Bright Futures Tool and Resource Kit Maternal Depression: PHQ-2

13 Bright Futures Tool and Resource Kit 13 Bright Futures Tool and Resource Kit Maternal Depression: PHQ-9

14 Bright Futures Tool and Resource Kit 14 Bright Futures Tool and Resource Kit AUTISM CASE STUDY CHAT SCREENING 1. Does your child enjoy being swung, bounced on your knee, etc?YESNO 2. Does your child take an interest in other children?YESNO 3. Does your child like climbing on things, such as up stairs?YESNO 4. Does your child enjoy playing peek-a-boo/hide-and-seek?YESNO 5. Does your child ever PRETEND, for example, to make a cup of tea using a toy cup and teapot, or pretend other things?YESNO toy cup and teapot, or pretend other things?YESNO 6. Does your child ever use index finger to point, to ASK for something?YESNO 7. Does your child ever use his/her index finger to point, to indicate INTEREST in something? YESNO INTEREST in something? YESNO 8. Can your child play properly with small toys (eg. cars or bricks) without just mouthing, fiddling or dropping them?YESNO without just mouthing, fiddling or dropping them?YESNO 9. Does your child ever bring objects over to you SHOW you something?YESNO

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16 Bright Futures Tool and Resource Kit 16 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

17 Bright Futures Tool and Resource Kit 17 Bright Futures Tool and Resource Kit ESTABLISHING A WORKFLOW !!!

18 Bright Futures Tool and Resource Kit 18 Bright Futures Tool and Resource Kit WORKFLOW PREVISIT QUESTIONNAIRE WORK 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 Bright Futures Tool and Resource Kit 19 Bright Futures Tool and Resource Kit WORKFLOW SCREENING QUESTIONNAIRE FOLLOW 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 – ADMINISTER MCHAT – IF POSITIVE SET FOLLOW UP PROCESS

20 Bright Futures Tool and Resource Kit 20 Bright Futures Tool and Resource Kit 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 Bright Futures Tool and Resource Kit 21 Bright Futures Tool and Resource Kit There is a family from Laos at the homeless shelter; child had been playing with their children Worried about additional shots because boyfriend’s mother had a child with autism

22 Bright Futures Tool and Resource Kit 22 Bright Futures Tool and Resource Kit Quality Measures for Preventive Services All 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 Bright Futures Tool and Resource Kit 23 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

24 Bright Futures Tool and Resource Kit 24 Bright Futures Tool and Resource Kit References Hagan JF, Shaw JS, Duncan PM, eds 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 Bright Futures Tool and Resource Kit 25 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

26 Bright Futures Tool and Resource Kit 26 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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28 Bright Futures Tool and Resource Kit 28 Bright Futures Tool and Resource Kit Periodicity Schedule