Parent report and electronic medical record agreement on asthma education provided and children’s tobacco smoke exposure

Harrington, Kathy; Haven, Kristen; Nuño, Velia Leybas; Magruder, Theresa; Bailey, William C.; Gerald, Lynn B.

doi:10.3109/02770903.2013.828303

Cited by 2 publications

(1 citation statement)

References 34 publications

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“…Our findings were similar to those of other studies in different settings. A study of children with asthma recruited from health departments and asthma clinics 26 found poor agreement across all clinics between EHR documentation and parent report, although agreement was higher within asthma specialty clinics (k 0.410 compared with 0.205). In 1 study of infants and young children in a primary care clinic, reported TSE based on 1 question about exposure to passive TSE was 13% compared with 55% with cotinine-verified exposure.…”

Section: Discussionmentioning

confidence: 99%

Electronic Health Record Classification of Tobacco Smoke Exposure and Cotinine Levels in Hospitalized Pediatric Patients

Mahabee‐Gittens

Merianos

Gordon

et al. 2019

Hospital Pediatrics

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Documentation of children's tobacco smoke exposure (TSE) in the electronic health record (EHR) can have important implications for clinical care. However, it may not be accurate if it is not based on biochemical assessment, the most reliable method of verifying TSE. Our objectives were to compare the accuracy of EHR classification of TSE with cotinine verification and to explore parent and child variables associated with biochemically verified TSE. METHODS:Participants were 171 hospitalized pediatric patients (ages 0-17 years; mean age 5.1 [SD 3.7] years) who had EHR documentation of TSE and measured salivary cotinine. Children with cotinine levels .1 ng/mL were classified as having biochemical verification of TSE. Parents reported sociodemographic characteristics, and children's EHRs were abstracted for TSE status, past medical history, and diagnoses. We conducted x 2 tests to assess the agreement between EHR classification of TSE status and cotinine levels. Then, we assessed the relationship between sociodemographic and clinical variables and cotinine using crude and adjusted logistic regression models.RESULTS: Overall, 71% (121 of 171) of EHR classifications were correct on the basis of cotinine levels. Specificity analyses showed that 77% (53 of 69) were correctly identified as exposed to tobacco smoke. Sensitivity analyses showed that 67% (68 of 102) were correctly identified as unexposed. The negative predictive value was 0.61 (53 of 87); 39% (34 of 87) were misclassified as unexposed. The positive predictive value was 0.81 (68 of 84); 19% (16 of 84) were misclassified as exposed.CONCLUSIONS: Almost 40% of children were misclassified in the EHR as unexposed to tobacco smoke. Biochemical verification should be used as part of universal TSE screening during pediatric hospitalizations.

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Section: Discussionmentioning

confidence: 99%

Electronic Health Record Classification of Tobacco Smoke Exposure and Cotinine Levels in Hospitalized Pediatric Patients

Mahabee‐Gittens

Merianos

Gordon

et al. 2019

Hospital Pediatrics

View full text Add to dashboard Cite

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Tobacco-Related Counseling and Documentation in Adolescent Primary Care Practice: Challenges and Opportunities

LeLaurin

Theis

Thompson

et al. 2019

Nicotine &Amp; Tobacco Research

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Introduction Primary care visits present an opportunity to reduce tobacco use and tobacco smoke exposure (TSE) among adolescents. To date, few studies have examined tobacco-related electronic health record (EHR) documentation in adolescent visits. The purpose of this study was to (1) describe tobacco-related EHR documentation practices in adolescent care clinics, including whether alternative tobacco products, parental use, and TSE were addressed; and (2) identify aspects of adolescent tobacco use that may inform EHR updates and counseling and documentation practices. Methods Following a convergent mixed-methods design, we conducted an EHR review of 508 adolescent well-child visits, performed focus groups with pediatric providers and staff, and conducted in-depth interviews with adolescent patients. Record review data and interview transcripts were analyzed and interpreted concurrently. Results In the EHR review, cigarette screening was documented in 92.3% of visits, smokeless tobacco screening in 51.4%, parental tobacco use in 23.2%, and home TSE in 33.1% of visits. Smoking status options were not mutually exclusive and did not include noncigarette products. No records documented assessment of e-cigarette use, despite nearly half of adolescent interview respondents citing these as the most popular products among adolescents. In interviews, adolescents discussed their experiences with alternative tobacco/nicotine products more than cigarettes. Conclusions Tobacco use status prompts should be revised for clarity and include noncigarette tobacco products and TSE. Provider education on noncigarette products and TSE assessment is needed. Improvements in EHR systems, resources, and tools can lead to better tobacco screening, prevention, and treatment practices among primary care providers. Implications Clinical guidelines call for pediatricians to assess and treat adolescent and parental tobacco use during primary care visits. The use of electronic health records (EHRs) can improve screening and counseling practices; however, few studies have examined tobacco-related EHR documentation practices in adolescent care settings. This mixed-methods study found low rates of EHR documentation related to noncigarette nicotine/tobacco products, parental tobacco use, and tobacco smoke exposure. These results demonstrate the need for increased provider training and EHR modifications to facilitate comprehensive tobacco control efforts in the adolescent population.

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Parent report and electronic medical record agreement on asthma education provided and children’s tobacco smoke exposure

Abstract: We found low concordance between the parent's report and the electronic medical record for smoke exposure and asthma education provided. Un- or under-documented smoke exposure and health education have the potential to affect continuity of care for pediatric patients with asthma.

Cited by 2 publications

References 34 publications

Electronic Health Record Classification of Tobacco Smoke Exposure and Cotinine Levels in Hospitalized Pediatric Patients

Electronic Health Record Classification of Tobacco Smoke Exposure and Cotinine Levels in Hospitalized Pediatric Patients

Tobacco-Related Counseling and Documentation in Adolescent Primary Care Practice: Challenges and Opportunities

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