At many doctor appointments, providers ask a series of questions designed to screen patients for a variety of potential health problems. But that can take a lot of time.
To help providers focus more directly on patients’ needs during appointments, Rush’s Pediatric Primary Care Center launched a project to get questions to patients in advance.
The Pediatric Primary Care Welcome Project has two parts:
- Patients are sent questionnaires in MyChart before their appointments; if patients don’t have MyChart or don’t complete the questionnaires, they’re given an iPad upon arrival and asked to complete the questionnaires while waiting for their appointment.
- Patients’ answers populate the providers’ notes for that visit, and specific results may prompt providers to provide necessary guidance and referrals.
Asking patients to answer questions beforehand allows providers to spend more time talking to patients about their concerns and addressing their other chronic medical conditions. Parents with proxy access to their child’s account answer the questionnaires on behalf of their child.
“The questionnaires gave us a chance to reflect on our child’s development ahead of the appointment and come up with questions. They really helped streamline the appointment and saved us time once we were there.“ says Kim Blanchard, who has used the questionnaires for both of her children (ages 3 years and 3 months old).
Expanding best practice screenings and early intervention referrals
This innovative use of questionnaires before pediatric appointments also allows Rush pediatricians to expand its use of best practice screenings. These include screenings for post-partum depression, adverse childhood experiences for parents of newborns, developmental and behavioral screening for young children, mental health screenings for adolescents and general wellness screening for all families including nutrition, sleep, school functioning, dental health and social determinants of health screenings. These preventive health screenings are promoted by the American Academy of Pediatrics Bright Futures best practices for pediatric health.
Pediatricians can then address concerns that arise for patients or parents who screen “positive” on any of these screenings —meaning they score high enough or otherwise indicate there may be an issue. Some concerns can be addressed through in-office counseling or guidance, and others may require more intensive support from programs specific to a family’s needs.
One such program is Building Early Connections. When young children screen positive for developmental delays or behavioral difficulties, pediatricians refer families to the Building Early Connections team, which helps through providing individualized parent support, behavioral intervention sessions and coordination of care with other early intervention services and specialists.
From the launch of the Pediatric Primary Care Welcome project in September2020 to August 2021, over 5,000 patients were screened and 1 in 5 of those screenings were served by the Building Early Connections team. Such referrals are key to ensuring these families get the support they need as early as possible to support healthy development and thrive.
Blanchard says they haven’t noticed anything concerning with their children so far, but that the questionnaires provided “a nice reference for us as parents. They helped us think about where our children should be. I think if something comes up in the future, these questionnaires would be a useful tool to help facilitate the conversation.”
She added, “They did help us realize that we needed to bring our 3-year-old daughter to the dentist.”
Social determinants of health
The social determinants of health screening is also an important part of the questionnaires. Parents/caregivers are asked about child care needs, transportation needs, food and housing security and other social needs that affect overall health and well-being. To date, the Rush Pediatric Primary Care team has completed 8,633 screenings for social determinants of health and shared over 6,700 resources for patients who need them.
One of the key ways Rush providers refer patients to social needs resources is through NowPow — a resource platform integrated within Epic that Rush adopted in 2017 that allows health care providers to “prescribe” non-clinical resources and social services in their patients’ own communities. This integration allows for referral tracking and, for some organizations, even allows a deeper understanding of service utilization.
“I’m very proud of the Pediatric Primary Care Welcome Project,” says Melissa Holmes, MD, associate chief medical informatics officer and pediatric provider at Rush. “It’s exciting that we’ve been able leverage what we have to help patients, increase our efficiency and reduce provider burnout, all at the same time.”