An adolescent health questionnaire (AHQ) is driving dramatic improvements in sensitive, well-visit discussions at Children’s Hospital of Philadelphia (CHOP). In recently published research, the hospital reported nearly 95% of patients ages 13 to 21 shared information on topics like gun safety, substance abuse, sexual activity and orientation, and gender identity. The rate was less than 25% before implementing the new tablet-based AHQ.
The need for the novel questionnaire became apparent when a hospital researcher couldn’t find enough participants to enroll in a study. For a potential vaping cessation clinical trial, Brian Jenssen, MD, MSHP, sought participants by looking at more than 93,000 well visits between 2018 and 2020. Even with a tobacco/e-cigarette prompt in the electronic medical record and other communication efforts across the CHOP system, fewer than 2% of patients reported recent tobacco or e-cigarette use.
This statistic didn’t align with national data showing rates of more than 20% among the same population. Upon review, Jenssen discovered the vaping question simply wasn’t being asked. Time constraints and patient confidentiality were two primary reasons. In other instances, clinicians posed the query in a way that discouraged a positive response.
Though the vaping trial didn’t pan out, it highlighted the need for a better way to communicate with adolescents. “That's what led to this effort,” said Jenssen, a researcher and primary care pediatrician with the Division of General Pediatrics at CHOP. “The initial failure forced us to pivot to this much more embracing and engaging approach.”
Electronic screener addresses traditional well-visit challenges
In the new AHQ approach, adolescents receive a tablet upon check-in at their well-visit appointment and are encouraged to complete the confidential survey independently. Depending on their responses, the AHQ can cover up to 55 questions and take several minutes to finish.
The completed survey feeds directly into the patient’s EMR. Visual cues prompt the clinician to discuss pertinent topics raised in the questionnaire. Further, CHOP built clinical decision support systems into the workflow to provide staff with additional resources. For example, a patient reporting sexual activity generates information on birth control or labs to screen for sexually transmitted infections. Jenssen and his team fast-tracked the tool’s integration into the hospital’s IT systems by enlisting The Possibilities Project (TPP), an innovation incubator at CHOP.
Feedback from health care providers, patients, and parents alike has been overwhelmingly positive, according to Jenssen. The electronic survey provides adolescents with the confidentiality they want, and it “primes” the family to anticipate the discussion—alleviating some of the awkwardness for clinicians when requesting some privacy from the child’s parents. The response-based prompts in the EMR ensure the clinician makes efficient use of limited well-visit time.
“It's a great way to supercharge the visit between the pediatrician and the patient,” Jenssen said.
The standardization of the questionnaire in an electronic format also ensures uniformity—all questions are asked of every participant in the same manner. “There's certainly an equity angle,” Jenssen said. “Every child, regardless of their demography or any preconceived notions, is asked the same questions.”
Results pave way for future plans
Building on the success of the electronic AHQ’s implementation, Jenssen and his team foresee three next steps:
- Spreading the word. Jenssen and his team hope to advise children’s health systems around the country on adopting this AHQ approach. He stresses the electronic component is helpful but not necessary—paper questionnaires can accomplish many of the same goals.
- Building parent surveys. The CHOP team is considering a similar screening tool for parents; many have said they appreciate how the AHQ helps promote potentially uncomfortable conversations with their children. “That really warmed my heart,” Jenssen said. “It’s a clinical efficiency tool, but we’re trying to empower parents as well.”
- Improving community health. To date, CHOP has administered more than 70,000 questionnaires while sustaining a 91% completion rate. This high participation rate gives clinicians a snapshot of emerging adolescent health trends. The data can help inform broader population health initiatives, particularly on topics such as gun and auto safety, reproductive health, and tobacco use.
