National Healthcare Quality and Disparities Report
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AHRQ Research Studies Date
Topics
- Alcohol Use (1)
- Ambulatory Care and Surgery (1)
- Anxiety (1)
- Asthma (2)
- Behavioral Health (9)
- Care Coordination (1)
- Caregiving (1)
- Care Management (2)
- Case Study (2)
- (-) Children/Adolescents (25)
- Chronic Conditions (2)
- Clinical Decision Support (CDS) (1)
- Clinician-Patient Communication (1)
- Community-Based Practice (1)
- Decision Making (3)
- Depression (4)
- Diagnostic Safety and Quality (1)
- Disparities (1)
- Education: Continuing Medical Education (1)
- Electronic Health Records (EHRs) (1)
- Emergency Department (3)
- Evidence-Based Practice (4)
- Guidelines (4)
- Healthcare Delivery (1)
- Healthcare Utilization (2)
- Health Information Technology (HIT) (2)
- Health Services Research (HSR) (1)
- Implementation (2)
- Low-Income (2)
- Medical Errors (1)
- Medical Expenditure Panel Survey (MEPS) (1)
- Medication (1)
- Obesity (2)
- Pain (1)
- Patient-Centered Healthcare (1)
- Patient Experience (1)
- Payment (1)
- Practice Patterns (3)
- Prevention (4)
- (-) Primary Care (25)
- Primary Care: Models of Care (2)
- Provider (1)
- Provider: Physician (1)
- Quality Improvement (2)
- Quality Indicators (QIs) (1)
- Quality Measures (1)
- Quality of Care (2)
- Research Methodologies (1)
- Respiratory Conditions (1)
- Screening (3)
- Skin Conditions (1)
- Social Determinants of Health (1)
- Substance Abuse (4)
- Tobacco Use (2)
- Tobacco Use: Smoking Cessation (2)
- Training (1)
- U.S. Preventive Services Task Force (USPSTF) (4)
- Vulnerable Populations (1)
- Young Adults (2)
AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 25 Research Studies DisplayedRadovic A, Odenthal K, Flores AT
Prescribing technology to increase uptake of depression treatment in primary care: a pre-implementation focus group study of SOVA (Supporting Our Valued Adolescents).
Supporting Our Valued Adolescents (SOVA) is a web-based technology intervention designed to increase depression and anxiety treatment uptake by adolescents in the context of an anonymous peer community with an accompanying website for parents. With a goal of informing the design of a hybrid effectiveness-implementation randomized controlled trial, we conducted a pre-implementation study in two primary care practices to guide implementation strategy development. We conducted focus groups with primary care providers (PCPs) at three different timepoints with PCPs (14 total) from two community practices.
AHRQ-funded; HS022989.
Citation: Radovic A, Odenthal K, Flores AT .
Prescribing technology to increase uptake of depression treatment in primary care: a pre-implementation focus group study of SOVA (Supporting Our Valued Adolescents).
J Clin Psychol Med Settings 2020 Dec;27(4):766-82. doi: 10.1007/s10880-019-09669-5.
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Keywords: Children/Adolescents, Depression, Anxiety, Behavioral Health, Primary Care, Health Information Technology (HIT), Implementation
Harder VS, Shaw JS, McCulloch CE
Statewide asthma learning collaborative participation and asthma-related emergency department use.
This study looked at outcomes from participation of pediatric practices in a quality improvement (QI) collaborative to decrease asthma-related emergency department (ED) visits. A statewide network of practices participated in the collaborative from 2015 to 2016. Asthma-related ED visit rates per 100 child-years for children ages 3 to 21 was evaluated using the state’s all-payer claims databases. The authors found that in the postintervention year (2017) participating practices’ ED visit rate decreased by 5.8 per 100 child-years, compared to an increase of 1.8 per 100 child-years in non-participating practices. There were no statistically significant differences in asthma-related ED visit rates during 2016, which indicated that it took some time for QI elements to be successfully implemented in pediatric practices.
AHRQ-funded; HS025297.
Citation: Harder VS, Shaw JS, McCulloch CE .
Statewide asthma learning collaborative participation and asthma-related emergency department use.
Pediatrics 2020 Dec;146(6):e20200213. doi: 10.1542/peds.2020-0213..
Keywords: Children/Adolescents, Asthma, Emergency Department, Quality Improvement, Quality of Care, Primary Care, Guidelines
Mills J, Wonoprabowo L
AHRQ Author: Mills J
Primary care-based interventions to prevent illicit drug use in children, adolescents, and young adults.
This case study concerns a 14-year-old patient who presents for a well-child visit. The patient eats a healthy diet, is part of a local soccer league, is an overall good student, and just started high school in the fall. The patient denies trying any illicit substances but reports trying to “get high” from cough syrup. Three questions are presented, and answers provided.
AHRQ-authored.
Citation: Mills J, Wonoprabowo L .
Primary care-based interventions to prevent illicit drug use in children, adolescents, and young adults.
Am Fam Physician 2020 Oct 15;102(8):493-94..
Keywords: Children/Adolescents, Young Adults, Substance Abuse, Primary Care, Prevention, U.S. Preventive Services Task Force (USPSTF), Case Study, Guidelines, Evidence-Based Practice
Callejo-Black A, Wagner DV, Ramanujam K
A systematic review of external validity in pediatric integrated primary care trials.
This study used the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework to conduct a systematic review of external validity reporting in integrated primary care (IPC) interventions for mental health concerns. A literature search was conducted to identify relevant literature from 1998 to 2018 reporting on open, randomized or quasi-randomized trials of IPC interventions that targeted child (ages 0-18 years) psychological symptoms. The authors included 39 publications describing 25 studies in the review. Publications rarely reported indicators of external validity, including the representatives of participants (12%), rate of adoption clinics or providers (16%), cost of implementation (8%), or evidence of maintenance (16%). Few studies also included key pragmatic factors such as cost or organizational change processes related to implementation and maintenance.
AHRQ-funded; HS022981.
Citation: Callejo-Black A, Wagner DV, Ramanujam K .
A systematic review of external validity in pediatric integrated primary care trials.
J Pediatr Psychol 2020 Oct 1;45(9):1039-52. doi: 10.1093/jpepsy/jsaa068..
Keywords: Children/Adolescents, Primary Care, Behavioral Health, Healthcare Delivery, Evidence-Based Practice, Health Services Research (HSR), Research Methodologies
Fan T, Smith HJ
AHRQ Author: Fan T
Primary care interventions for prevention and cessation of tobacco use in children and adolescents.
In this case study, three questions are posed concerning a 13-year-old girl presenting for a routine well-child visit who reports that she has never used tobacco products in any form.
AHRQ-authored.
Citation: Fan T, Smith HJ .
Primary care interventions for prevention and cessation of tobacco use in children and adolescents.
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Keywords: U.S. Preventive Services Task Force (USPSTF), Case Study, Children/Adolescents, Tobacco Use: Smoking Cessation, Tobacco Use, Primary Care, Prevention, Substance Abuse
Riley AR, Walker BL, Hall TA
Development and initial validation of a measure of parents' preferences for behavioral counseling in primary care.
There is a significant need to understand the factors that contribute to parents' consumer preferences for behavioral health services in pediatric primary care; however, no validated measure of such preferences exists. In this article, the investigators discuss the development of the BIPS (Behavioral Information Preferences Scale), a measure of parents' preferences for delivery of behavioral guidance in pediatric primary care and assessed its psychometric properties.
AHRQ-funded; HS022981.
Citation: Riley AR, Walker BL, Hall TA .
Development and initial validation of a measure of parents' preferences for behavioral counseling in primary care.
Fam Syst Health 2020 Jun;38(2):139-50. doi: 10.1037/fsh0000481..
Keywords: Children/Adolescents, Behavioral Health, Primary Care, Caregiving
Fiori KP, Rehm CD, Sanderson D
Integrating social needs screening and community health workers in primary care: the community linkage to care program.
This study used logistic regression to identify factors associated with successful social service uptake in an urban pediatric practice. Out of 4948 households screened for social needs from December 2017 to November 2018, 20% self-reported at least one factor. Only 43% of the 287 households with unmet needs reported social service uptake. Greater than 4 outreach encounters were significantly associated with successful referrals. This study suggests the need for additional research and an opportunity for further program optimization.
AHRQ-funded; HS026396.
Citation: Fiori KP, Rehm CD, Sanderson D .
Integrating social needs screening and community health workers in primary care: the community linkage to care program.
Clin Pediatr 2020 Jun;59(6):547-56. doi: 10.1177/0009922820908589..
Keywords: Children/Adolescents, Community-Based Practice, Primary Care, Social Determinants of Health, Implementation, Low-Income
Fishbein AB, Hamideh N, Lor J
Management of atopic dermatitis in children younger than two years of age by community pediatricians: a survey and chart review.
The authors characterized primary care providers' (PCPs) practice patterns for atopic dermatitis (AD) in children under 2 years of age and determined the need for AD guidelines for PCPs focused on this age group. They found that PCP management of AD in children under 2 years of age is different from that of older children, with possible underuse of medium/high-potency topical corticosteroids. They recommended clear guidelines for this age group.
AHRQ-funded; HS023011.
Citation: Fishbein AB, Hamideh N, Lor J .
Management of atopic dermatitis in children younger than two years of age by community pediatricians: a survey and chart review.
J Pediatr 2020 Jun;221:138-44.e3. doi: 10.1016/j.jpeds.2020.02.015..
Keywords: Children/Adolescents, Skin Conditions, Provider: Physician, Practice Patterns, Primary Care, Medication, Care Management
Luk JW, Parker EO, Richardson LP
Sexual attraction and experiences in the primary care setting: examining disparities in satisfaction with provider and health self-efficacy.
This study examines whether sexual minority adolescents report lower satisfaction with primary care providers and lower health self-efficacy compared to heterosexual males and females. Data from 535 adolescents who participated in one of two randomized clinical trials were analyzed. Both sets of adolescents reported high satisfaction with providers. Relative to heterosexual males, sexual minority males reported lower self-efficacy in reaching health goals. Sexual minority females reported lower confidence in positively impacting their own health and lower self-efficacy in setting health goals compared to heterosexual females.
AHRQ-funded; HS023383.
Citation: Luk JW, Parker EO, Richardson LP .
Sexual attraction and experiences in the primary care setting: examining disparities in satisfaction with provider and health self-efficacy.
J Adolesc 2020 Jun;81:96-100. doi: 10.1016/j.adolescence.2020.04.009..
Keywords: Children/Adolescents, Patient Experience, Primary Care, Clinician-Patient Communication, Vulnerable Populations, Disparities
O'Connor E, Thomas R, Senger CA
Interventions to prevent illicit and nonmedical drug use in children, adolescents, and young adults: updated evidence report and systematic review for the US Preventive Services Task Force.
The authors reviewed the benefits and harms of interventions to prevent illicit and nonmedical drug use in children, adolescents, and young adults to inform the US Preventive Services Task Force. They found that the evidence for behavioral counseling interventions to prevent initiation of illicit and nonmedical drug use among adolescents and young adults was inconsistent and imprecise, with some interventions associated with reduction in use and others associated with no benefit or increased use. Health, social, and legal outcomes were sparsely reported, and few showed improvements.
AHRQ-funded; 2902015000017I.
Citation: O'Connor E, Thomas R, Senger CA .
Interventions to prevent illicit and nonmedical drug use in children, adolescents, and young adults: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2020 May 26;323(20):2067-79. doi: 10.1001/jama.2020.1432..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Young Adults, Substance Abuse, Primary Care, Prevention, Guidelines, Evidence-Based Practice
Kuhns LM, Carlino B, Greeley K
A chart review of substance use screening and related documentation among adolescents in outpatient pediatric clinics: implications for practice.
This study looked at rates of substance use screening and related documentation among adolescents aged 12-17 in outpatient pediatric clinics in a large academic medical center. The authors abstracted a random sample of 127 records and coded clinical notes to describe screening cases and related characteristics. They then analyzed descriptive patterns within the data to calculate screening rates, characteristics of screening, and identify related factors. Rates of screening by providers was 72% for each common substance and a total of 6% of patients reported substance use during screening.
AHRQ-funded; HS026385.
Citation: Kuhns LM, Carlino B, Greeley K .
A chart review of substance use screening and related documentation among adolescents in outpatient pediatric clinics: implications for practice.
Subst Abuse Treat Prev Policy 2020 May 25;15(1):36. doi: 10.1186/s13011-020-00276-4..
Keywords: Children/Adolescents, Substance Abuse, Screening, Ambulatory Care and Surgery, Alcohol Use, Practice Patterns, Primary Care
Kovalerchik O, Powers E, Holland ML
Differences in frequency of visits to pediatric primary care practices and emergency departments by body mass index.
The purpose of this retrospective study was to examine differences in utilization across health care settings among children by body mass index (BMI) categories to help identify opportunities for interventions. The authors concluded that the children's BMI categories were associated with health care utilization, specifically primary care visits, ED visits, and hospitalizations.
AHRQ-funded; HS024332.
Citation: Kovalerchik O, Powers E, Holland ML .
Differences in frequency of visits to pediatric primary care practices and emergency departments by body mass index.
Acad Pediatr 2020 May-Jun;20(4):532-39. doi: 10.1016/j.acap.2019.12.011..
Keywords: Children/Adolescents, Primary Care, Emergency Department, Obesity, Healthcare Utilization
Selph S, Patnode C, Bailey SR
Primary care-relevant interventions for tobacco and nicotine use prevention and cessation in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
Interventions to discourage the use of tobacco products (including electronic nicotine delivery systems or e-cigarettes) among children and adolescents may help decrease tobacco-related illness and injury. The objective of this study was to update the 2013 review on primary care-relevant interventions for tobacco use prevention and cessation in children and adolescents to inform the US Preventive Services Task Force.
AHRQ-funded; 290201500009I.
Citation: Selph S, Patnode C, Bailey SR .
Primary care-relevant interventions for tobacco and nicotine use prevention and cessation in children and adolescents: updated evidence report and systematic review for the US Preventive Services Task Force.
JAMA 2020 Apr 28;323(16):1599-608. doi: 10.1001/jama.2020.3332..
Keywords: U.S. Preventive Services Task Force (USPSTF), Children/Adolescents, Tobacco Use, Tobacco Use: Smoking Cessation, Prevention, Primary Care, Evidence-Based Practice, Guidelines
Peterson EL, Ndumele CD, Busch SH
National referral and treatment patterns among mental health pediatric primary care visits.
The current study explored factors that predict referral from pediatric primary care to mental health specialty care among a nationally representative sample of visits. Results indicated that patient visits that included rarer/serious diagnoses (e.g., bipolar disorder) were more likely to receive a referral in comparison to those with ADHD.
AHRQ-funded; HS017589.
Citation: Peterson EL, Ndumele CD, Busch SH .
National referral and treatment patterns among mental health pediatric primary care visits.
Adm Policy Ment Health 2020 Jan;47(1):86-93. doi: 10.1007/s10488-019-00972-9..
Keywords: Children/Adolescents, Behavioral Health, Primary Care, Practice Patterns
Stafford AM, Garbuz T, Etter DJ
The natural course of adolescent depression treatment in the primary care setting.
Little is known about how adolescents receive depression follow-up in primary care. The purpose of this study was to describe the rates of symptom assessment and depression treatment over time in a group of adolescents screening positive for moderate or severe depression in the primary care setting. Retrospective chart reviews were conducted to gather information related to symptom reassessments, antidepressant prescriptions, psychotherapy referrals, and treatment discontinuation.
AHRQ-funded; HS022681.
Citation: Stafford AM, Garbuz T, Etter DJ .
The natural course of adolescent depression treatment in the primary care setting.
J Pediatr Health Care 2020 Jan-Feb;34(1):38-46. doi: 10.1016/j.pedhc.2019.07.002..
Keywords: Children/Adolescents, Depression, Behavioral Health, Primary Care
Grout RW, Thompson-Fleming R, Carroll AE
Prevalence of pain reports in pediatric primary care and association with demographics, body mass index, and exam findings: a cross-sectional study.
The objective of this study was to determine the rate of positive pain screenings in pediatric primary care and evaluate the relationship between reported pain and obesity, demographics, and exam findings during routine pediatric encounters. The investigators concluded that pain is common in general pediatric encounters, and occurs more frequently in obese children and those who previously reported pain. Pain reporting may be influenced by seasonal variation and clinic factors.
AHRQ-funded; HS020640; HS018453; HS017939.
Citation: Grout RW, Thompson-Fleming R, Carroll AE .
Prevalence of pain reports in pediatric primary care and association with demographics, body mass index, and exam findings: a cross-sectional study.
BMC Pediatr 2018 Nov 21;18(1):363. doi: 10.1186/s12887-018-1335-0..
Keywords: Children/Adolescents, Obesity, Pain, Children/Adolescents, Primary Care
Wolf ER, Hochheimer CJ, Sabo RT
Gaps in well-child care attendance among primary care clinics serving low-income families.
This retrospective cohort study of children 0 to 6 years old between 2011 and 2016 within 2 health networks spanning 20 states, sought to determine which specific well-child visits (WCVs) are most frequently missed and whether age-specific patterns of attendance differ by race or insurance type. The investigators found that the 15- and 18-month WCVs as well as the 4-year WCV are the least frequently attended WCVs.
AHRQ-funded; HS024270.
Citation: Wolf ER, Hochheimer CJ, Sabo RT .
Gaps in well-child care attendance among primary care clinics serving low-income families.
Pediatrics 2018 Nov;142(5). doi: 10.1542/peds.2017-4019..
Keywords: Children/Adolescents, Low-Income, Children/Adolescents, Primary Care
Liu TL, Taylor YJ, Mahabaleshwarkar R
Shared decision making and time to exacerbation in children with asthma.
This study examined the use of shared decision making (SDM) to delay exacerbation in children with asthma. A prospective cohort of children at five primary care practices in Charlotte, North Carolina that serve vulnerable population was studied between 2011 and 2013. The cohort included 746 children, with 60.5% male and 54.2% African American with a mean age of 8.6 years. The final analysis included 100 matched pairs of children for use of SDM and normal care. There was a marginally significant difference in the time of exacerbation between the two groups.
AHRQ-funded; HS019946.
Citation: Liu TL, Taylor YJ, Mahabaleshwarkar R .
Shared decision making and time to exacerbation in children with asthma.
J Asthma 2018 Sep;55(9):949-55. doi: 10.1080/02770903.2017.1378357..
Keywords: Children/Adolescents, Decision Making, Asthma, Respiratory Conditions, Chronic Conditions, Primary Care
Yonek JC, Jordan N, Dunlop D
Patient-centered medical home care for adolescents in need of mental health treatment.
The patient-centered medical home (PCMH) has emerged as an optimal primary care model for all youth; however, little is known about the extent to which adolescents in need of mental health (MH) treatment receive care consistent with the PCMH. This study assessed (1) 10-year trends in PCMH care among U.S. adolescents according to MH need and (2) variations in PCMH care and its subcomponents among adolescents with MH need, by individual and family characteristics.
AHRQ-funded; HS024183.
Citation: Yonek JC, Jordan N, Dunlop D .
Patient-centered medical home care for adolescents in need of mental health treatment.
J Adolesc Health 2018 Aug;63(2):172-80. doi: 10.1016/j.jadohealth.2018.02.006..
Keywords: Medical Expenditure Panel Survey (MEPS), Children/Adolescents, Behavioral Health, Patient-Centered Healthcare, Primary Care: Models of Care, Primary Care
Lewis Gilbert A, McCord AL, Ouyang F
Characteristics associated with confidential consultation for adolescents in primary care.
This study examines how provider report of confidential consultation in the electronic health record is associated with adolescent characteristics, health risk factors, and provider training. The study found that provider training is needed to reinforce the importance of confidential consultation for all adolescents.
AHRQ-funded; HS022681.
Citation: Lewis Gilbert A, McCord AL, Ouyang F .
Characteristics associated with confidential consultation for adolescents in primary care.
J Pediatr 2018 Aug;199:79-84.e1. doi: 10.1016/j.jpeds.2018.02.044..
Keywords: Children/Adolescents, Education: Continuing Medical Education, Electronic Health Records (EHRs), Primary Care, Training
Arthur KC, Mangione-Smith R, Burkhart Q
Quality of care for children with medical complexity: an analysis of continuity of care as a potential quality indicator.
The objective of this study was to examine the relationship between continuity of care for children with medical complexity (CMC) and emergency department (ED) utilization, care coordination quality, and family effects related to care coordination. The investigators measured ED utilization and primary care continuity with the Bice-Boxerman continuity of care index for 1477 CMC using administrative data from Minnesota and Washington state Medicaid agencies. They concluded that continuity of care holds promise as a quality measure for CMC because of its association with lower ED utilization and more frequent receipt of care coordination.
AHRQ-funded; HS020506.
Citation: Arthur KC, Mangione-Smith R, Burkhart Q .
Quality of care for children with medical complexity: an analysis of continuity of care as a potential quality indicator.
Acad Pediatr 2018 Aug;18(6):669-76. doi: 10.1016/j.acap.2018.04.009..
Keywords: Care Coordination, Children/Adolescents, Chronic Conditions, Emergency Department, Healthcare Utilization, Primary Care, Quality of Care, Quality Indicators (QIs), Quality Measures
Rinke ML, Singh H, Heo M
Diagnostic errors in primary care pediatrics: Project RedDE.
The objective of this study was to investigate the frequency of two high-frequency/subacute diagnostic errors (DEs), and one missed opportunity for diagnosis (MOD) in primary care pediatrics. DE or MOD rates in pediatric primary care were found to be 54 percent for patients with elevated BP, 11 percent for patients with abnormal laboratory values, and 62 percent for adolescents with an opportunity to evaluate for depression.
AHRQ-funded; HS022087; HS023608; HS023602.
Citation: Rinke ML, Singh H, Heo M .
Diagnostic errors in primary care pediatrics: Project RedDE.
Acad Pediatr 2018 Mar;18(2):220-27. doi: 10.1016/j.acap.2017.08.005.
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Keywords: Children/Adolescents, Diagnostic Safety and Quality, Medical Errors, Primary Care, Quality Improvement
Riley AR, Grennan A, Menousek K
Pediatric primary care psychologists' reported level of integration, billing practices, and reimbursement frequency.
The aim of this study was to investigate the relationships between psychologists' reported billing practices, reimbursement rates, and model of integration in pediatric primary care. Survey results showed a clear pattern of higher integration being associated with greater utilization of health & behavior codes and better reimbursement for consultation activities.
AHRQ-funded; HS022981.
Citation: Riley AR, Grennan A, Menousek K .
Pediatric primary care psychologists' reported level of integration, billing practices, and reimbursement frequency.
Fam Syst Health 2018 Mar;36(1):108-12. doi: 10.1037/fsh0000306..
Keywords: Behavioral Health, Children/Adolescents, Payment, Primary Care, Provider
Aalsma MC, Zerr AM, Etter DJ
Physician intervention to positive depression screens among adolescents in primary care.
The objective of this study was to determine the effectiveness of computer-based screening and physician feedback to guide adolescent depression management within primary care. The investigators found that when a computer-based decision support system algorithm focused on adolescent depression and was implemented in two primary care clinics, a majority of physicians utilized screening results to guide clinical care.
AHRQ-funded; HS022681.
Citation: Aalsma MC, Zerr AM, Etter DJ .
Physician intervention to positive depression screens among adolescents in primary care.
J Adolesc Health 2018 Feb;62(2):212-18. doi: 10.1016/j.jadohealth.2017.08.023..
Keywords: Care Management, Children/Adolescents, Decision Making, Depression, Health Information Technology (HIT), Behavioral Health, Primary Care, Primary Care: Models of Care, Screening
Etter DJ, McCord A, Ouyang F
Suicide screening in primary care: use of an electronic screener to assess suicidality and improve provider follow-up for adolescents.
The purpose of this study was to assess the feasibility of using an existing computer decision support system to screen adolescent patients for suicidality and provide follow-up guidance to clinicians in a primary care setting. The authors concluded that incorporating adolescent suicide screening and provider follow-up guidance into an existing computer decision support system in primary care was feasible and well utilized by providers.
AHRQ-funded; HS022681.
Citation: Etter DJ, McCord A, Ouyang F .
Suicide screening in primary care: use of an electronic screener to assess suicidality and improve provider follow-up for adolescents.
J Adolesc Health 2018 Feb;62(2):191-97. doi: 10.1016/j.jadohealth.2017.08.026..
Keywords: Children/Adolescents, Clinical Decision Support (CDS), Decision Making, Depression, Behavioral Health, Primary Care, Screening