Internal Medicine-Pediatrics Resident University of Colorado Denver, Colorado, United States
Background: In non-integrated pediatric health systems, Electronic Health Records (EHR) may lack tools for identifying parenting teens at routine infant visits. Yet, these visits may be an opportunity to address the intergenerational primary care needs of teen mothers, including unmet contraceptive needs.
Objective: To compare standard and tailored electronic health record (EHR) tools’ ability to identify teen mothers during infant pediatric primary care visits.
Design/Methods: This retrospective cohort study used EHR data from a large, urban pediatric primary care practice. Maternal age data were abstracted for January 2015-December 2019 from birth history, social history and insurance fields (standard cohort). Data for January 2018-December 2019 were abstracted from an EHR template (tailored cohort). We compared maternal age documentation in the standard versus tailored cohorts, and estimated the prevalence of teen mothers in each cohort. Chi-square tests of independence with post-hoc pairwise differences analysis were used for analysis.
Results: Of the 9,292 and 3,119 infants in the standard and tailored cohorts, 85.9% (standard error 3.2%) and 83.4% (0.9%) had maternal age documented, respectively (p<0.001). Documentation increased in the standard cohort from 79.3% (2015) to 96.1% (2019), but decreased in the tailored cohort from 83.4% (2018) to 82.4% (2019). In the standard cohort, maternal age documentation was higher in birth history and insurance fields than social history: 68.8% (2.8%), 61.2% (8.0%), and 0.2% (0.04%), respectively (p<0.001). Of infants with documented maternal age, the proportion with teen mothers was the same and decreased over time in both cohorts. Conclusion(s): Standard EHR tools had higher maternal age documentation, but this data may be harder to access during point-of-care service delivery. Tailored tools may better enable identification of teen mothers and co-located preventive service provision.
Maternal age documentation rates using standard tools increased throughout the study period. However, documentation rates using a tailored tool surpassed provider documentation using standard birth history fields. Tailored documentation data is more easily accessible in the EHR and stored in a format that facilitates clinical and research applications.
A decrease in the proportion of infants with teen mothers was observed throughout the study period at the study site, on par with city and national trends. The proportion of infants with teen mothers remained significantly higher than those of Philadelphia and the nation.
Authors/Institutions: Sutton Higgins, CHOP, Philadelphia, Pennsylvania, United States; Emily Gregory, CHOP, Philadelphia, Pennsylvania, United States; Aletha Akers, PolicyLab at CHOP, Philadelphia, Pennsylvania, United States
