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Quality improvement in pediatric well care with an electronic record
1Children's Health Specialists, Cayuga County Department of Health, Auburn, NY, USA.
Insights
Electronic medical records (EMR) improve pediatric well-child care, but insurance coverage significantly impacts lead testing rates. Children with insurance were over 42 times more likely to receive this crucial screening.
Area of Science:
- Pediatric Health
- Health Informatics
- Public Health
Background:
- Children's Health Specialists has utilized an electronic medical record (EMR) for four years.
- The EMR incorporates standardized forms for well-child visits (American Academy of Pediatrics) and educational materials (Bright Futures).
Purpose of the Study:
- To evaluate the completeness of pediatric well-child care within the practice.
- Specifically examining well-visit completion, instruction distribution, immunization rates, and lead testing for children born in 1998.
Main Methods:
- Retrospective analysis of patient records for children born in 1998.
- Assessment of data completeness related to well-child visits, provided instructions, immunizations, and blood lead level testing.
Main Results:
- Children attending well-child visits received recommended instructions and were generally well-immunized.
- A significant disparity in blood lead testing was observed: children with insurance coverage were 42.6 times more likely to undergo testing (RR 42.6, 95% CI 10.6-171.3).
Conclusions:
- The EMR system facilitates high-quality pediatric well-child care.
- External factors, particularly insurance coverage for lead testing, present significant barriers to comprehensive care, especially for high-risk populations.
Abstract:
For the past 4 years the pediatric office of Children's Health Specialists has used an electronic medical record (EMR). The EMR has forms for the routine well child visits recommended by the American Academy of Pediatrics (AAP) [1] and instruction sheets with key information on development and safety as recommended by "Bright Futures" [2]. In this study the completeness of well visits, instruction distribution, immunizations and lead testing were examined for all children in our practice with birthdays in 1998. When children did get to the office they did get their instruction sheets on child development and safety and were well immunized. Children who had insurance coverage to pay for in-office lead testing were 42.6 times more likely to have blood lead testing done: Risk Ratio 42.6, lower limit 10.6, upper limit 171.3. Insurance coverage and regulatory changes would likely increase lead screening markedly in high risk populations. Our implementation of our EMR has helped us to deliver high quality pediatric well child care but external obstacles limit the completeness of the care.