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Implementation of an Electronic Approach to Psychosocial Screening in a Network of Pediatric Practices
J Michael Murphy1, Salpi Stepanian2, Alexa Riobueno-Naylor3
1Department of Psychiatry (JM Murphy, A Riobueno-Naylor, JM Holcomb, A Dutta, MS Jellinek), Massachusetts General Hospital, Boston, Mass; Department of Psychiatry (JM Murphy, MS Jellinek), Harvard Medical School, Boston, Mass.
Insights
Routine electronic screening using the Pediatric Symptom Checklist-17 parent-report (PSC-17P) significantly improved in pediatric practices over two years. Screening rates increased, but risk factors varied by practice, insurance, sex, and age.
Area of Science:
- Pediatric healthcare quality improvement
- Child and adolescent mental health screening
- Health informatics and electronic health records
Background:
- Pediatric Symptom Checklist-17 parent-report (PSC-17P) is a tool for assessing psychosocial distress in children.
- Electronic administration of patient-reported outcomes can enhance efficiency in clinical settings.
- Quality improvement initiatives aim to optimize screening processes and identify at-risk youth.
Purpose of the Study:
- To assess the implementation and effectiveness of electronically administered PSC-17P screening over two years in a pediatric network.
- To evaluate changes in screening rates and identify demographic and practice-level factors associated with PSC-17P risk.
- To determine the feasibility of routine psychosocial screening in diverse pediatric practice settings.
Main Methods:
- A network of 18 pediatric practices implemented electronic PSC-17P for children aged 5.50–17.99 years during well-child visits.
- Screening data and billing information were collected over two years, analyzing baseline and implementation phases.
- Statistical analysis examined screening rates, positive screen rates, and variations by practice, insurance, sex, and age.
Main Results:
- Screening rates significantly improved from 26.3% at baseline to 89.3% during full implementation in year one.
- In year two, 77.9% of eligible patients were screened, with significant variations observed across the 18 practice locations.
- PSC-17P risk rates demonstrated significant differences based on practice, insurance type, patient sex, and age group.
Conclusions:
- Routine electronic administration of the PSC-17P is feasible and effective in improving screening rates within pediatric practices.
- The study confirms that psychosocial risk identified by PSC-17P varies significantly across different patient demographics and practice characteristics.
- This quality improvement project highlights the value of integrated electronic screening tools for identifying children needing further psychosocial assessment.
Objective:
A network of 18 pediatric practice locations serving predominantly commercially insured patients implemented the electronic administration of the Pediatric Symptom Checklist-17 parent-report (PSC-17P) for all 5.50- to 17.99-year-old children seen for well child visits (WCVs) and wrote up the results as a quality improvement project. The current study investigated this screening over 2 years to assess its implementation and risk rates over time.
Methods:
Parents completed the PSC-17P electronically before the visit and the scored data were immediately available in the patient's chart. Using billing and screening data, the study tracked rates of overall and positive screening during the first-year baseline (4 months) and full implementation phases of the project in the first (8 months) and second (12 months) year.
Results:
A total of 35,237 patients completed a WCV in the first year. There was a significant improvement in PSC-17P screening rates from the first-year baseline (26.3%) to full implementation (89.3%; P < .001) phases. In the second year, a total of 40,969 patients completed a WCV and 77.9% (n = 31,901) were screened, including 18,024 patients with screens in both years. PSC-17P screening rates varied significantly across the 18 locations and rates of PSC-17P risk differed significantly by practice, insurance type, sex, and age.
Conclusions:
The current study demonstrated the feasibility of routine psychosocial screening over 2 years using the electronically administered PSC-17P in a network of pediatric practices. This study also corroborated past reports that PSC-17 risk rates differed significantly by insurance type (Medicaid vs commercial), sex, and age group.
