Overview: The majority of adolescent morbidity and mortality can be attributed to preventable risk factors. Most adolescents visit a primary care provider once a year, providing the opportunity to integrate prevention into clinical encounters. Guidelines targeting the delivery of adolescent preventive services have been developed, but are not being implemented as recommended. Provider and system-level barriers, including insufficient training and inadequate screening and charting tools, have been identified. However, research to address these barriers and increase the delivery of adolescent preventive services in primary care settings is limited.
Aim : To determiner whether a systems intervention in a managed health care organization, utilizing the Precede-Proceed model as a framework for implementing provider training and customized screening and charting tools, results in higher rates of provider delivery of clinical preventive services than using usual Standard of Care. Population: Primary care providers in Pediatric clinics caring for adolescents in a large HMO will be targeted. Methods: In this experimental design, 5 clinics will be assigned randomly to two conditions: 3 into the Intervention condition and 2 into the Comparison condition. The Intervention condition is comprised of two components: training and tools. Two 4-hour training workshops will be conducted as well as a booster trainings. Providers also will receive tools which include an adolescent health screening questionnaire and a customized charting form that incorporates information from the screening questionnaire and provides reminder prompts, cues and a format for documentation of services. Comparison clinics will continue to use their usual standard of care. Provider delivery of preventive services will be assessed through provider self-reports and independent adolescent patient reports following their routine well care visits. Analyses will focus on the assessment of within-provider changes in the probabilities of screening an adolescent between the different study conditions and comparisons of these changes between the Intervention and Comparison sites.

Agency
National Institute of Health (NIH)
Institute
Agency for Healthcare Research and Quality (AHRQ)
Type
Research Demonstration--Cooperative Agreements (U18)
Project #
5U18HS011095-02
Application #
6391183
Study Section
Special Emphasis Panel (ZHS1-HSRD-A (02))
Program Officer
Slutsky, Jean
Project Start
2000-09-30
Project End
2003-08-31
Budget Start
2001-09-01
Budget End
2002-08-31
Support Year
2
Fiscal Year
2001
Total Cost
Indirect Cost
Name
University of California San Francisco
Department
Pediatrics
Type
Schools of Medicine
DUNS #
073133571
City
San Francisco
State
CA
Country
United States
Zip Code
94143
Ozer, Elizabeth M; Adams, Sally H; Orrell-Valente, Joan K et al. (2011) Does delivering preventive services in primary care reduce adolescent risky behavior? J Adolesc Health 49:476-82
Ozer, Elizabeth M; Zahnd, Elaine G; Adams, Sally H et al. (2009) Are adolescents being screened for emotional distress in primary care? J Adolesc Health 44:520-7
Buckelew, Sara M; Adams, Sally H; Irwin Jr, Charles E et al. (2008) Increasing clinician self-efficacy for screening and counseling adolescents for risky health behaviors: results of an intervention. J Adolesc Health 43:198-200