Adolescent Well Child Examinations in the Midwest

Abstract

Well child examinations (WCEs) are annual comprehensive preventive care visits conducted to address age-appropriate physical, psychosocial, and developmental milestones set forth by the American Academy of Pediatrics and Bright Futures. As adolescents assume responsibility for their own health habits, they are at a critical juncture where preventative screenings and education serve an important role in future development, yet only 29% of adolescents are seeing their healthcare providers to address these vital issues. Behaviors learned in adolescence have a strong influence on adult lifestyle choices, illustrating further necessity for WCEs guided by health care providers during these developmental years. This mixed-methods project integrates qualitative and quantitative tools to evaluate health care providers’ beliefs, general clinic processes, and the overall quality of WCEs among adolescents aged 11 to 17 years in two midwestern primary care clinics. Qualitative data was obtained through focus group interviews. Quantitative data was obtained through automatically generated reports and manual electronic health record (EHR) chart audits. Qualitative results indicated that prompts for age-appropriate highrisk behaviors are not triggered within the EHR until 17 to 18 years at the Kansas clinic whereas triggers were present for all ages at the Iowa clinic. Though Iowa had substantially higher screening rates, both clinics were found to be deficient in high-risk behavior and mental health screenings along with addressing immunization status during WCEs when compared to national averages. Clinic recommendations to improve the quality and completion rate of adolescent WCEs included encouraging the use of standardized assessments, age appropriate EHR triggers, and the use of marketing materials and EHR appointment reminders.