715 - Improving Screening in Pediatric Primary Care: Evaluation of EHR Integrated Tablet-based Screening in a Large Public Hospital System
Friday, April 25, 2025
5:30pm – 7:45pm HST
Publication Number: 715.5244
Shivali Choxi, The Children's Hospital at Montefiore, West Nyack, NY, United States; Katherine Piwnica-Worms, NYU Grossman School of Medicine, New York, NY, United States; Ariel Charney, NYC Health+Hospitals, New York City, NY, United States; Cynthia estrada, New York University Grossman School of Medicine, new york, NY, United States; Marion Billings, New York University Grossman School of Medicine, New York, NY, United States; Ashani Pandita, New York Institute of Technology College of Osteopathic Medicine, Queens, NY, United States; Arthur H. Fierman, NYU Grossman School of Medicine, Glen Rock, NJ, United States; Jasmine White, NYC Health+ Hospitals, Jamaica, NY, United States; Suzy Tomopoulos, New York University Grossman School of Medicine, New York, NY, United States
Pediatrician and Director of Pediatric Primary Care Innovation New York City Health and Hospitals West Nyack, New York, United States
Background: To enhance screening in pediatric primary care (PPC), NYC Health+Hospitals implemented a systemwide Electronic Health Record (EHR)-integrated, multi-lingual tablet-based screening program for developmental, mental health, and social needs screens. Objective: To assess impact and patient/provider satisfaction with systemwide tablet-based screening using a mixed-methods approach. Design/Methods: Using EHR data, we compared monthly screening rates over a 12-month period pre/post-tablet introduction among patients seen for a well-child visit and due for developmental (SWYC), autism (POSI/MCHAT), maternal and adolescent depression (PHQ-9), or social needs screening. Screening trends were evaluated using an interrupted time series with a Poisson generalized linear model fit to each screening type. Results were stratified by race/ethnicity and primary language. Additionally, patients, parents and providers were surveyed using random convenience sampling to assess post-intervention satisfaction. Results: Overall, screening rates increased over time with most demonstrating uptrending slopes even prior to adoption of tablets due to prior quality improvement initiatives (QI) (Fig. 1). Screening rates for social needs [IRR: 1.77, P< 0.001] and adolescent depression [IRR: 1.05, P< 0.05] increased immediately following implementation, and an increased slope post-tablets was observed for SWYC [IRR = 1.01, p< 0.05] and social needs screening [IRR = 1.04, p< 0.001] (Table 2). By race/ethnicity and primary language, improvements were observed post-tablets for social needs screening across all subgroups. Developmental screening improvements were observed among the Hispanic/Latinx, Asian/NHPI, and Spanish-speaking subgroups (Table 2).
Survey results (Table 3) show high percentages of primary care providers (PCPs) endorse a positive overall experience (62%), and that tablets improved patient problem identification (88%), opportunities for referral (91%) and education (93%). Both patient/parents and PCPs endorsed tablets improved PCP understanding of family needs (84%) and the overall quality of care (86%).
Conclusion(s): n the largest public hospital system in the country serving 160,000+ patients in PPC, incorporating EHR-integrated tablets to ongoing QI work augmented social needs and developmental screening rates overall and among some race-ethnicity and language subgroups. Surveys also show high patient and provider satisfaction. Understanding the additive benefit of tablets on certain screens and populations and downstream effects on health outcomes warrants future study.
Table 2 Table 3.pdfQuestions administered to a total of 90 patients and parents with a response rate of 61% and a total of 150 providers (PCP, nurses and PCAs) with a response rate of 33%, who participated in tablet-based screening and the results of their level of satisfaction with it. In the analysis, responses of "strongly agree" and "agree" ’were grouped together as a positive response and displayed in the table, and responses of ‘‘strongly disagree’’and‘‘disagree’’ were grouped as a negative response. Responses of "neither agree or disagree" were excluded. A notation of "−" means the question was not surveyed because it was not applicable to that survey population.
