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Disparities in Medical Documentation for Pediatric Headache in the Emergency Department
Danielle J Kellier1,2, Marissa Anto2,3, Naomi T Hughes4
1Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania.
Insights
Clinical notes for pediatric emergency department (ED) headache visits are less thorough for younger patients and boys. Pain severity significantly impacts note completeness, suggesting a need for interventions to improve documentation quality for all children.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Informatics
- Health Services Research
Background:
- Thorough clinical documentation is crucial for effective healthcare delivery and patient safety.
- Previous research has not fully explored the factors influencing the completeness of clinical notes for pediatric emergency department (ED) visits specifically for headache.
- Understanding these factors can help identify areas for quality improvement in documentation.
Purpose of the Study:
- To investigate the associations between patient demographics, socioeconomic factors, and clinical characteristics with the thoroughness of clinical notes for children presenting to a pediatric ED with headache.
- To identify specific patient groups whose headache-related ED visits may have less complete medical documentation.
Main Methods:
- Secondary analysis of a retrospective chart review of first-time pediatric ED visits for headache (ages 5-17).
- Data extracted included provider note fields relevant to headache diagnosis and triage acuity.
- Backward stepwise log-binomial regression was used to identify factors associated with missing data in clinical notes, with a sensitivity analysis including imputed pain severity.
Main Results:
- Of 629 eligible visits, notes were less thorough for younger patients, boys, and those with lower triage acuity scores.
- Non-Hispanic black children had lower odds of being triaged at moderate or severe acuity.
- After including pain severity, patients with severe pain had decreased risk of missing data, and sex differences in note completeness became non-significant.
Conclusions:
- Clinical notes for pediatric ED headache visits demonstrate variability in thoroughness, being less complete for younger patients, males, and those with lower triage scores.
- Mild pain severity was also associated with less thorough notes after accounting for pain.
- The observed associations between missing documentation and demographic factors highlight potential disparities and the need for targeted interventions to enhance healthcare interaction quality.
Objectives:
We examined associations between patients' socioeconomic and clinical factors and the thoroughness of clinical notes for children visiting the pediatric emergency department (ED) for headache.
Methods:
This is a secondary analysis of data from a retrospective chart review of first-time visits for patients (ages 5-17) seen for headache at 1 pediatric ED, excluding visits related to infection or injury. We extracted fields from the provider note relevant to headache diagnosis (eg, pain severity) and used backward stepwise log-binomial regressions to identify demographic and clinical factors associated with missing data for a single field. For our sensitivity analysis, we included imputed pain severity as another predictor.
Results:
From 1000 randomly selected ED visits, we found 629 eligible visits, skewing toward adolescents (median: 13.0 y [IQR: 10.0-15.8 y]) and females (58.5%). Non-Hispanic black children had lower odds of being triaged at moderate or severe acuity even after adjusting for pain severity, age, and sex assigned at birth (OR: 0.07 [95% CI: 0.03-0.16]). Older patients (RR 0.99 per year [0.98-0.99], P<0.001) and those with moderate (0.79 [0.75-0.82], P<0.001) or high-acuity (0.90 [0.85-0.96], P=0.001) triage scores had a decreased risk of missing data; boys had an increased risk (1.04 [1.00-1.08], P=0.046). After pain severity was included, patients with severe pain (0.92 [0.88-0.97], P=0.003) had a decreased risk of missing data while sex differences became nonsignificant (P=0.063).
Conclusions:
Provider notes for children seen in the ED for headache are less thorough for younger patients, boys, and those with lower triage acuity scores. After accounting for pain severity, patients reporting mild pain also had less thorough notes. If the quality of medical documentation represents the health care interaction, relationships between missingness and demographic factors such as sex warrant exploration of potential interventions.
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