Implementation of an electronic teen questionnaire (eTeenQ) for risk behavior screening during adolescent well visits in a large integrated health system: A pilot intervention (Preprint)

Abstract

Background: Screening for risk behaviors is a routine and essential component of adolescent preventive health primary care visits. Early identification of risk behaviors can inform targeted counseling and care at the time of the visit. If stored in discrete fields in the electronic health record (EHR), adolescent screening data can also be used to understand risk behaviors across a clinic or health system, or to support quality improvement projects.

Objective: The goals of this pilot study were to adapt and implement an existing paper adolescent risk behavior screening tool for use as an electronic data capture tool (eTeenQ), to evaluate patient and clinician acceptance of the eTeenQ, and to describe the prevalence of the selected risk behaviors reported through the eTeenQ.

Methods: The multidisciplinary project team applied an iterative process to develop the 29-item eTeenQ. Two unique data entry forms were created with attention to a) user interface and user experience, b) the need to maintain patient privacy, and c) the potential to transmit and store data for future use in clinical care and research. Three primary care clinics within a large health system piloted the eTeenQ from August 17, 2020, to August 27, 2021. During preventive health visits for adolescents 12-18 years, the eTeenQ was completed on tablets and responses were converted to a provider-display for teens and primary care providers to review together. ETeenQ responses were stored in a REDCap database, and for patients who agreed, transferred to an EHR flowsheet. Responses to selected eTeenQ questions are reported among those consenting to research. At the conclusion of the pilot, the study team conducted in-person or virtual semi-structured interviews with participating clinic providers and staff, to understand their experience using the eTeenQ.

Results: Among 2816 eligible adolescents with well visits, 2098 (74%) completed the eTeenQ. Of these 86% agreed to store responses in the EHR. Of 1632 who consented for research, 90% reported having an adult they can really talk to, 93% reported feeling safe in their community, yet 25% reported someone they lived with had a gun and 11% reported having had a stressful or scary event that still bothered them. Ten percent reported they were or wondered if they were gay, lesbian, bisexual, pansexual, asexual, or other, 3% reported they were or wondered if they were transgender or gender diverse. Staff and providers shared that they preferred the eTeenQ over the paper screening tool; they felt that the eTeenQ improved confidentiality and willingness among adolescents to answer sensitive questions.

Conclusion: The electronic capture of adolescent risk behaviors is feasible in a busy clinic setting and preferred by staff and clinicians. In addition, most adolescents are comfortable having their responses to risk behavior screening stored in the EHR.