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A simple clinical coding strategy to improve recording of child maltreatment concerns: an audit study
Andrew Peter McGovern1, Jenny Woodman, Janice Allister
1University of Surrey. andy@mcgov.co.uk.
Insights
A simple coding strategy significantly improved the recording of child maltreatment concerns in primary care. This enhanced documentation aids in identifying at-risk children and facilitating information sharing among healthcare providers.
Area of Science:
- Child Health
- Medical Informatics
- Public Health
Background:
- Professional guidelines from the General Medical Council (GMC) and National Institute for Health and Clinical Excellence (NICE) recommend recording child maltreatment concerns.
- Evidence indicates substantial under-recording of child maltreatment, including minor concerns, in primary care settings.
Purpose of the Study:
- To evaluate the effectiveness of a straightforward coding strategy in enhancing the recording of maltreatment-related concerns within electronic primary care records.
- To identify barriers and facilitators to implementing such a coding strategy.
Main Methods:
- A clinical audit was conducted in 11 English family practices, comparing maltreatment-related coding rates before (2010-2011) and after (2012) implementing a simple coding strategy.
- The strategy encouraged the consistent use of the Read code 'Child is cause for concern'.
- A qualitative service evaluation explored barriers to recording.
Main Results:
- The implementation of the coding strategy led to significant increases in the recording of any maltreatment-related code (rate ratio 1.4) and child protection procedures (RR 1.4).
- Recording of 'child was a cause for concern' codes saw a substantial rise (RR 2.5).
- Clinicians identified the strategy's simplicity as a key factor in its successful implementation.
Conclusions:
- A simple coding strategy effectively improved the recording of child maltreatment concerns by general practitioners in the studied practices.
- The improved recording has the potential to enhance the identification of children at risk and facilitate better information sharing.
- Further research is recommended to explore how recording practices can optimally support the doctor-patient relationship.
Background:
Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC) and National Institute for Health and Clinical Excellence (NICE) but there is evidence of substantial under-recording.
Aim:
To determine whether a simple coding strategy improved recording of maltreatment-related concerns in electronic primary care records.
Design And Setting:
Clinical audit of rates of maltreatment-related coding before January 2010-December 2011 and after January-December 2012 implementation of a simple coding strategy in 11 English family practices. The strategy included encouraging general practitioners to use, always and as a minimum, the Read code 'Child is cause for concern'. A total of 25,106 children aged 0-18 years were registered with these practices. We also undertook a qualitative service evaluation to investigate barriers to recording.
Method:
Outcomes were recording of 1) any maltreatment-related codes, 2) child protection proceedings and 3) child was a cause for concern.
Results:
We found increased recording of any maltreatment-related code (rate ratio 1.4; 95% CI 1.1-1.6), child protection procedures (RR 1.4; 95% CI 1.1-1.6) and cause for concern (RR 2.5; 95% CI 1.8-3.4) after implementation of the coding strategy. Clinicians cited the simplicity of the coding strategy as the most important factor assisting implementation.
Conclusion:
This simple coding strategy improved clinician's recording of maltreatment-related concerns in a small sample of practices with some 'buy-in'. Further research should investigate how recording can best support the doctor-patient relationship. HOW THIS FITS IN: Recording concerns about child maltreatment, including minor concerns, is recommended by the General Medical Council (GMC) and National Institute for Health and Clinical Excellence (NICE), but there is evidence of substantial under-recording. We describe a simple clinical coding strategy that helped general practitioners to improve recording of maltreatment-related concerns. These improvements could improve case finding of children at risk and information sharing.
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