Prevention/Care Management, 2004
Kaiser Permanente of Northern California
As a result of AHRQ-funded research, Kaiser Permanente of Northern California developed guidelines for adolescents aimed at preventing the leading causes of morbidity and mortality in this population.
The AHRQ-funded research of Dr. Charles Irwin, MD, director of adolescent medicine and professor of pediatrics at the University of California at San Francisco, helped shape the Kaiser guidelines. Dr. Irwin developed an algorithm of key questions for pediatricians to ask adolescents that included tobacco use, bicycle helmet and seat belt use, and sexual habits. Customized screening and charting tools were also developed for pediatricians so they would have the questions readily on hand.
The guidelines developed reflected both on the reality of the time constraints of pediatricians and the adolescent population they serve. Dr. Irwin felt that it would be better for healthcare professionals to focus on key areas for prevention that could be changed rather than to try to fulfill all the recommended guidelines of the American Medical Association (AMA) or the American Academy of Pediatrics (AAP).
Preliminary data demonstrated that the three Kaiser clinics that took part in an intervention program were able to change adolescent behavior and improve health habits compared with the two clinics that were used as control groups. With these findings, Kaiser Permanente developed its own patient guidelines, which incorporated both the AHRQ research and the findings of their own clinicians.
According to Charles J. Wibbelsman, MD, chief, The Teenage Clinic, Kaiser Permanente of Northern California, Kaiser is the largest provider of care to adolescents in California. "About 500,000 adolescents aged 11 to 19 are enrolled in the [health] plan. Of these health plan members, 70 percent are utilizers [of services] and have visited a medical office within the past two years."
Dr. Wibbelsman says, "Although there is recognition about the importance of prevention, the guidelines of both the AMA and the AAP are too diffuse. If pediatricians followed these guidelines, each assessment could last much longer than an hour visit and would not be practical in a busy office practice. In addition, they may not reflect the reality of the teenage population. Current clinical preventive guidelines often do not emphasize the need for training physicians and other healthcare professionals to talk to adolescents without their parents present."
The study, called "Pro-Teens: Promoting Healthy Lifestyles for Teens," recruited three thousand 14-year-olds from Kaiser medical centers in San Jose, Roseville, and South Sacramento. Two medical centers where adolescents also received traditional medical treatment were used as controls.
The adolescents taking part in the study were followed through three annual visits to doctors, nurse practitioners, and health educators who were trained to screen adolescents for risky behavior and communicate potentially life-saving messages. "Our goal was to assess whether behaviors in these areas that lead to the most serious health problems or death of teens can be prevented or stopped," Dr. Wibbelsman explains.
The importance of screening adolescents and detecting health problems is important since the population is large and growing rapidly. In 1999, there were 39.4 million adolescents aged 10 to 19 in the United States. It is estimated that by 2005, that number will increase by more than two million. In its latest report, the Centers for Disease Control and Prevention found 35,960 deaths among adolescents and young adults between the ages of 10 and 24. This represents a death rate of 64.7 per 100,000. According to the CDC, about 75 percent of these deaths are due to preventable causes including injury, violence, HIV/STDs, substance abuse (including tobacco), and poor mental health.
Impact Case Study Identifier: COE 04-09
AHRQ-Sponsored Activity: Research
Topic(s): Pediatrics, Adolescent Health
McManus MA, Graham RR, Fox HB, Mercil CM, Irwin CE, Jr. How far have state Medicaid agencies advanced in performance measurement for children? Archives of Pediatrics and Adolescent Medicine 154(7):665-671, 2000. (HS11095)
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Current as of September 2009
Impact Case Studies and Knowledge Transfer Case Studies: Prevention/Care Management, 2004. September 2009. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/about/casestudies/pcm/pcm2004.htm