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Before-Visit Questionnaire: A Tool to Augment Communication and Decrease Provider Documentation Burden in Pediatric
Yaa A Kumah-Crystal1, Preston M Stein2, Qingxia Chen1,3
1Department of Biomedical Informatics, Vanderbilt University, Nashville, Tennessee, United States.
Insights
A parent-facing electronic tool improved pediatric diabetes care by streamlining documentation. This before-visit questionnaire (BVQ) reduced provider typing by 50% and enhanced communication about disease management.
Area of Science:
- Pediatric Endocrinology
- Health Informatics
- Clinical Documentation Improvement
Background:
- Effective interval history collection is crucial for managing pediatric chronic conditions like diabetes.
- Provider documentation burden can impact the quality and efficiency of patient care.
- Parental involvement in healthcare data collection can enhance communication and adherence.
Purpose of the Study:
- To develop and evaluate an electronic tool for collecting interval history from parents.
- To assess the impact of this tool on provider documentation and patient care in pediatric diabetes.
- To determine the perceived usefulness and acceptability of the tool among parents and providers.
Main Methods:
- A parent-facing online before-visit questionnaire (BVQ) was implemented for pediatric diabetes patients.
- The BVQ collected interval history and self-management barriers, generating a provider summary note.
- Parent and provider satisfaction, documentation content/length, and provider typing time were assessed pre- and post-BVQ implementation.
Main Results:
- 79% of parents found the BVQ aided visit preparation, and 80% perceived improved visit quality.
- 100% of providers found the generated summary beneficial, with 81% desiring recent summaries.
- Provider documentation of adherence and barriers increased, and typing time for interval history was reduced by 50%.
Conclusions:
- Parent-completed BVQs that generate provider documentation are appreciated by both parents and providers.
- The BVQ system effectively redistributes workload, acceptable to both parents and providers.
- This approach enhances parent-provider communication and reduces provider workload in pediatric diabetes management.
Objective:
To develop and evaluate an electronic tool that collects interval history and incorporates it into a provider summary note.
Methods:
A parent-facing online before-visit questionnaire (BVQ) collected information from parents and caregivers of pediatric diabetes patients prior to a clinic encounter. This information was related to interval history and perceived self-management barriers. The BVQ generated a summary note that providers could paste in their own documentation. Parents also completed postvisit experience questionnaires. We assessed the BVQs perceived usefulness to parents and providers and compared provider documentation content and length pre- and post-BVQ rollout. We interviewed providers regarding their experiences with the system-generated note.
Results:
Seventy-three parents of diabetic children were recruited and completed the BVQ. A total of 79% of parents stated that the BVQ helped with visit preparation and 80% said it improved perceived quality of visits. All 16 participating providers reviewed BVQs prior to patient encounters and 100% considered the summary beneficial. Most providers (81%) desired summaries less than 1 week old. A total of 69% of providers preferred the prose version of the summary; however, 75% also viewed the bulleted version as preferable for provider review. Analysis of provider notes revealed that BVQs increased provider documentation of patients' adherence and barriers. We observed a 50% reduction in typing by providers to document interval histories. Providers not using summaries typed an average of 137 words (standard deviation [SD]: 74) to document interval history compared with 68 words [SD 47] typed with BVQ use.
Discussion:
Providers and parents of children with diabetes appreciated the use of previsit, parent-completed BVQs that automatically produced provider documentation. Despite the BVQ redistributing work from providers to parents, its use was acceptable to both groups.
Conclusion:
Parent-completed questionnaires on the patient's behalf that generate provider documentation encourage communication between parents and providers regarding disease management and reduce provider workload.
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