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• W2022244209 abstract "Sexually transmitted infections (STIs) remain a significant source of morbidity among adolescents. Many infections are asymptomatic, but pose significant risk for long-term sequelae. Urban communities, including the Bronx, are disproportionately affected. Primary care providers are well positioned to identify and treat STIs, yet many adolescents are not screened. The purpose of the Bronx Ongoing Pediatric Screening (BOPS) project is to improve rates of screening across 4 domains (newborn genetic, metabolic and infectious diseases; infant/toddler screening for developmental and social/emotional disorders; school age and adolescent mental health; and STIs) in a large Bronx primary care network. We report changes in screening for sexual activity and STIs (N. Gonorrhea, C. Trachomatis [GC] and HIV) among youth age 13-19. Intervention: BOPS, launched in March 2011, combines a modified learning collaborative, real-time clinical data feedback to practitioners and staff, quality improvement coaching, and a pay-for-quality monetary incentive using multidisciplinary onsite teams. Design: Comparison of 10 BOPS-participating sites (intervention) to 8 non-participating sites (control). Setting: A hospital-owned ambulatory network in the Bronx, NY. Main Outcomes/Measures: Rates of assessing sexual activity and ordering GC and HIV testing as documented in the adolescent template of the shared EMR; results of screening abstracted from the hospital's clinical information systems. Baseline rates of screening for GC and HIV varied across practices (16% to 84%, and 33% to 68%, respectively.) Between March 2011 - May 2013, the quarterly rate (median of weighted averages) of documented sexual activity during visits (in the EMR adolescent template) increased from 37% to 84% at BOPS sites and from 7% to 62% at non-BOPS sites. Among youth with sexual history documented as sexually active, quarterly screening rates for GC increased from 67% to 86% at BOPS sites and from 38% to 78% at non-BOPS sites. Among sexually active youth, HIV screening increased from 54% to 74% at BOPS sites and from 33% to 70% at non-BOPS sites. Among all youth with a visit to a BOPS site (not only those with documented sexual history), the annual proportion of GC tests to individuals increased from 15.4% pre-intervention [2010] to 19.8% in 2011, and to 34.7% in 2012. The proportion steadily increased for males (2010-12.3%, 2011-16.4%, 2012-25%) and females (2010-17.9%, 2011-22%, 2012-42.8%). At non-BOPS sites, the proportion of GC tests to individuals also improved from 12.1% pre-intervention to 14.7% in 2011 and 23.8% in 2012; the proportion increased less for males (2010-9.8%, 2011-11%, 2012- 16.4%) than for females (2010-14%, 2011-17.8%, 2012-30.3%). Our findings demonstrate that focused quality improvement (QI) efforts involving learning collaboratives, improvement coaching, EMR-generated data feedback and multi-disciplinary teams improve documentation of sexual activity and increase rates of STI screening for both male and female adolescents. Data from non-participating sites suggests that introduction of an adolescent template in the EMR results in improvement in screening rates regardless of participation in the BOPS collaborative; BOPS activities appear to promote additional improvement, especially for screening of adolescent males." @default.
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• W2022244209 date "2014-02-01" @default.
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• W2022244209 title "Improving Screening for Sexual Activity and STIs among Adolescents in Urban Primary Care: Results of a Learning Collaborative Approach to Quality Improvement" @default.
• W2022244209 doi "https://doi.org/10.1016/j.jadohealth.2013.10.140" @default.
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