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Before-Visit Questionnaire: A Tool to Augment Communication and Decrease Provider Documentation Burden in Pediatric DiabetesFunding This work was funded by the Vanderbilt Institute for Clinical and Translational Research VR14620.1 and National Institutes of Health (NLM) grant T15LM007450-13.
Objective To develop and evaluate an electronic tool that collects interval history and incorporates it into a provider summary note.
Methods A parent-facing online before-visit questionnaire (BVQ) collected information from parents and caregivers of pediatric diabetes patients prior to a clinic encounter. This information was related to interval history and perceived self-management barriers. The BVQ generated a summary note that providers could paste in their own documentation. Parents also completed postvisit experience questionnaires. We assessed the BVQs perceived usefulness to parents and providers and compared provider documentation content and length pre- and post-BVQ rollout. We interviewed providers regarding their experiences with the system-generated note.
Results Seventy-three parents of diabetic children were recruited and completed the BVQ. A total of 79% of parents stated that the BVQ helped with visit preparation and 80% said it improved perceived quality of visits. All 16 participating providers reviewed BVQs prior to patient encounters and 100% considered the summary beneficial. Most providers (81%) desired summaries less than 1 week old. A total of 69% of providers preferred the prose version of the summary; however, 75% also viewed the bulleted version as preferable for provider review. Analysis of provider notes revealed that BVQs increased provider documentation of patients' adherence and barriers. We observed a 50% reduction in typing by providers to document interval histories. Providers not using summaries typed an average of 137 words (standard deviation [SD]: 74) to document interval history compared with 68 words [SD 47] typed with BVQ use.
Discussion Providers and parents of children with diabetes appreciated the use of previsit, parent-completed BVQs that automatically produced provider documentation. Despite the BVQ redistributing work from providers to parents, its use was acceptable to both groups.
Conclusion Parent-completed questionnaires on the patient's behalf that generate provider documentation encourage communication between parents and providers regarding disease management and reduce provider workload.
Protection of Human and Animal Subjects
This study was reviewed and approved by the Institutional Review Board at Vanderbilt University Medical Center.
Received: 03 June 2021
Accepted: 25 August 2021
20 October 2021 (online)
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- 1 Kumah-Crystal YA, Hood KK, Ho YX. et al. Technology use for diabetes problem solving in adolescents with type 1 diabetes: relationship to glycemic control. Diabetes Technol Ther 2015; 17 (07) 449-454
- 2 Mulvaney SA, Hood KK, Schlundt DG. et al. Development and initial validation of the barriers to diabetes adherence measure for adolescents. Diabetes Res Clin Pract 2011; 94 (01) 77-83
- 3 Irvine AA, Saunders JT, Blank MB, Carter WR. Validation of scale measuring environmental barriers to diabetes-regimen adherence. Diabetes Care 1990; 13 (07) 705-711
- 4 Odegard PS, Gray SL. Barriers to medication adherence in poorly controlled diabetes mellitus. Diabetes Educ 2008; 34 (04) 692-697
- 5 Grant RW, Altschuler A, Uratsu CS. et al. Primary care visit preparation and communication for patients with poorly controlled diabetes: a qualitative study of patients and physicians. Prim Care Diabetes 2017; 11 (02) 148-153
- 6 Hood KK, Peterson CM, Rohan JM, Drotar D. Association between adherence and glycemic control in pediatric type 1 diabetes: a meta-analysis. Pediatrics 2009; 124 (06) e1171-e1179
- 7 Nathan DM. DCCT/EDIC Research Group. The Diabetes Control and Complications Trial/epidemiology of diabetes interventions and complications study at 30 years: overview. Diabetes Care 2014; 37 (01) 9-16
- 8 Tang PC, Overhage JM, Chan AS. et al. Online disease management of diabetes: engaging and motivating patients online with enhanced resources-diabetes (EMPOWER-D), a randomized controlled trial. J Am Med Inform Assoc 2013; 20 (03) 526-534
- 9 Pierce B. The use of Instant Medical History in a rural clinic. Case study of the use of computers in an Arkansas physician's office. J Ark Med Soc 2000; 96 (12) 444-447
- 10 Wenner AR, Ferrante M, Belser D. Instant Medical History. Proc Annu Symp Comput Appl Med Care 1994; •••: 1036
- 11 Hanmer J, Ray KN, McCracken P. et al. Uptake of an integrated electronic questionnaire system in community pediatric clinics. Appl Clin Inform 2021; 12 (02) 310-319
- 12 Grant RW, Wald JS, Schnipper JL. et al. Practice-linked online personal health records for type 2 diabetes mellitus: a randomized controlled trial. Arch Intern Med 2008; 168 (16) 1776-1782
- 13 Nordyke RA, Kulikowski CA. An informatics-based chronic disease practice: case study of a 35-year computer-based longitudinal record system. J Am Med Inform Assoc 1998; 5 (01) 88-103
- 14 Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009; 42 (02) 377-381
- 15 Ye C, Coco J, Epishova A. et al. A crowdsourcing framework for medical data sets. AMIA Jt Summits Transl Sci Proc 2018; 2017: 273-280
- 16 Slack WV, Hicks GP, Reed CE, Van Cura LJ. A computer-based medical-history system. N Engl J Med 1966; 274 (04) 194-198
- 17 Quaak MJ, Westerman RF, van Bemmel JH. Comparisons between written and computerised patient histories. Br Med J (Clin Res Ed) 1987; 295 (6591): 184-190
- 18 Porter SC, Silvia MT, Fleisher GR, Kohane IS, Homer CJ, Mandl KD. Parents as direct contributors to the medical record: validation of their electronic input. Ann Emerg Med 2000; 35 (04) 346-352
- 19 Dugaw Jr JE, Civello K, Chuinard C, Jones GN. Will patients use a computer to give a medical history?. J Fam Pract 2000; 49 (10) 921-923
- 20 Wald JS, Middleton B, Bloom A. et al. A patient-controlled journal for an electronic medical record: issues and challenges. Stud Health Technol Inform 2004; 107 (Pt 2): 1166-1170
- 21 Okoro AO. Preface: the 21st century cures act-a cure for the 21st century?. Am J Law Med 2018; 44 (2-3): 155