1
|
Shah SH, Woolf AD, Manning K, Holder-Niles F, Tully B, Flanagan S, Spence MC, Hauptman M. The more you know: Insights from integrated pre-visit surveys in a pediatric environmental health center. Int Public Health J 2023; 15:297-306. [PMID: 38362063 PMCID: PMC10868725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
The Pediatric Environmental Health Center (PEHC) at Boston Children's Hospital is a specialty referral clinic that provides consultation for approximately 250 patients annually. Identifying environmental hazards is key for clinical management. Exposure concerns include lead, mold, pesticides, perfluoroalkyl substances (PFAS), impaired air quality, and more. Our goal was to identify concerns and visit priorities of our patient population to guide visits. A 47-question pre-visit survey was created exploring potential environmental hazards and administered prior to visits using a platform integrated into the electronic medical record (EMR). The study group was a convenience sample of patients from June 2021 to June 2022. Of 204 total visits, 101 surveys were submitted, yielding a response rate of 49.5%. 66/101 (65.3%) were surveys from initial consultations used for descriptive analysis. The majority of patients were seen for a chief complaint of lead exposure (90.1%). Most respondents had concerns about peeling paint (40.0%), and those reporting peeling paint were more likely to report additional concerns [75.0%, p < 0.001]. Other concerns highlighted were mold (15.2%), pests (15.2%), asbestos (10.6%), air pollution (9.1%), temperature regulation (7.6%), pesticides (6.1%), PFAS (4.5%), and formaldehyde (4.5%). A knowledge gap was identified; 45.5% (30/66) respondents responded "no" to the question asking if the Poison Control Center phone number was stored in their phone. This study illustrates how the implementation of a pre-visit EMR integrated survey engages families, informs clinical care, and serves as a point-of-care education tool for specific knowledge gaps. Findings will guide development of future environmental health screeners.
Collapse
Affiliation(s)
- Shalini H Shah
- Pediatric Environmental Health Center, Boston Children’s Hospital, Boston, Massachusetts, USA
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Alan D Woolf
- Pediatric Environmental Health Center, Boston Children’s Hospital, Boston, Massachusetts, USA
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly Manning
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts, USA
| | - Faye Holder-Niles
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Bridget Tully
- Pediatric Environmental Health Center, Boston Children’s Hospital, Boston, Massachusetts, USA
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Shelby Flanagan
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew C Spence
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts, USA
| | - Marissa Hauptman
- Pediatric Environmental Health Center, Boston Children’s Hospital, Boston, Massachusetts, USA
- Region 1 New England Pediatric Environmental Health Specialty Unit, Boston, Massachusetts, USA
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Wilder JL, Nadar D, Gujral N, Ortiz B, Stevens R, Holder-Niles F, Lee J, Gaffin JM. Pediatrician Attitudes toward Digital Voice Assistant Technology Use in Clinical Practice. Appl Clin Inform 2019; 10:286-294. [PMID: 31042806 DOI: 10.1055/s-0039-1687863] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
OBJECTIVE Digital voice assistant technology provides unique opportunities to enhance clinical practice. We aimed to understand factors influencing pediatric providers' current and potential use of this technology in clinical practice. METHODS We surveyed pediatric providers regarding current use and interest in voice technology in the workplace. Regression analyses evaluated provider characteristics associated with voice technology use. Among respondents not interested in voice technology, we elicited individual concerns. RESULTS Among 114 respondents, 19 (16.7%) indicated current use of voice technology in clinical practice, and 51 (44.7%) indicated use of voice technology for nonclinical purposes. Fifty-four (47.4%) reported willingness to try digital voice assistant technology in the clinical setting. Providers who had longer clinic visits (odds ratio [OR], 3.11, 95% confidence interval [CI], 1.04, 9.33, p = 0.04), fewer patient encounters per day (p = 0.02), and worked in hospital-based practices (OR, 2.95, 95% CI, 1.08, 8.07, p = 0.03) were more likely to currently use voice technology in the office. Younger providers (p = 0.02) and those confident in the accuracy of voice technology (OR, 3.05, 95% CI, 1.38, 6.74, p = 0.005) were more willing to trial digital voice assistants in the clinical setting. Among respondents unwilling or unsure about trying voice assistant technology, the most common reasons elicited were concerns related to its accuracy (35%), efficiency (33%), and privacy (28%). CONCLUSION This national survey evaluating use and attitudes toward digital voice assistant technology by pediatric providers found that while only one-eighth of pediatric providers currently use digital voice assistant technology in the clinical setting, almost half are interested in trying it in the future. Younger provider age and confidence in the accuracy of voice technology are associated with provider interest in using voice technology in the clinical setting. Future development of voice technology for clinical use will need to consider accuracy of information, efficiency of use, and patient privacy for successful integration into the workplace.
Collapse
Affiliation(s)
- Jayme L Wilder
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States.,Harvard Medical School, Harvard University, Boston, Massachusetts, United States
| | - Devin Nadar
- Innovation & Digital Health Accelerator, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Nitin Gujral
- Innovation & Digital Health Accelerator, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Benjamin Ortiz
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, United States
| | - Robert Stevens
- Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, United States
| | - Faye Holder-Niles
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States.,Harvard Medical School, Harvard University, Boston, Massachusetts, United States
| | - John Lee
- Harvard Medical School, Harvard University, Boston, Massachusetts, United States.,Division of Allergy and Immunology, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Jonathan M Gaffin
- Harvard Medical School, Harvard University, Boston, Massachusetts, United States.,Division of Respiratory Diseases, Boston Children's Hospital, Boston, Massachusetts, United States
| |
Collapse
|
3
|
Abstract
Innovative approaches within primary care are needed to reduce fragmented care, increase continuity of care, and improve asthma outcomes in children with asthma. Our objective was to assess the impact of coordinated team-based asthma care on unplanned asthma-related health care utilization. A multidisciplinary asthma team was developed to provide coordinated care to high-risk asthma patients. Patients received an in-depth diagnostic and family needs assessment, asthma education, and coordinated referral to social and community services. Over a 2-year period, 141 patients were followed. At both 1 and 2 years postintervention, there was a significant decrease from preintervention rates in urgent care visits (40%, P = .002; 50%, P < .0001), emergency department visits (63%, P < .0001; 70%, P < .0001), and inpatient hospitalization (69%, P = .002; 54%, P = .04). Our coordinated asthma care program was associated with a reduction in urgent care visits, emergency department visits, and inpatient hospitalizations among high-risk children with asthma.
Collapse
Affiliation(s)
- Faye Holder-Niles
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | | | - Helen D'Couto
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | | | - Dionne A Graham
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Ann Chen Wu
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA.,3 Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Joanne E Cox
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| |
Collapse
|