Electronic Health Record Tools to Identify Child Maltreatment: Scoping Literature Review and Key Informant Interviews |
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| Institution: | 1. Duke University School of Medicine (L Stilwell, S Kaplan), Durham, NC;2. Sanford School of Public Policy (L Stilwell, E Gifford), Durham, NC;3. Center for Child and Family Policy (M Golonka, E Gifford), Durham, NC;4. Department of Psychology and Neuroscience (M Golonka), Center for the Study of Adolescent Risk and Resilience, Duke University, Durham, NC;5. Duke University (K Ankoma-Sey, M Yancy), Durham, NC;6. Duke Department of Pediatrics (L Terrell), Durham, NC;1. Department of Pediatrics (K O''Hara, SI Ziniel), University of Colorado School of Medicine, Aurora, Colo;2. Department of Pediatrics (A Tseng), Virginia Commonwealth University School of Medicine, Richmond, Va;3. Department of Hospital Medicine (S Moss), Cleveland Clinic Community Care, Cleveland, Ohio;4. Department of Pediatric Hospital Medicine (S Moss), Pediatrics Institute, Cleveland Clinic, Cleveland, Ohio;5. Division of Hospital Medicine, Department of Pediatrics (L Herbst, B Herbst), Cincinnati Children''s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio;6. Geriatrics & Palliative Care Division, Department of Family and Community Medicine (L Herbst), University of Cincinnati College of Medicine, Cincinnati, Ohio;7. Department of Pediatrics (S Marsicek), AdventHealth for Children, Orlando, Fla;8. Department of Pediatrics (K Molas-Torreblanca), Keck School of Medicine of USC, Los Angeles, Calif;9. Division of Hospital Medicine (K Molas-Torreblanca), Children''s Hospital Los Angeles, Los Angeles, Calif;10. Department of Internal Medicine (B Herbst), University of Cincinnati College of Medicine, Cincinnati, Ohio;11. Department of Pediatrics (J Maniscalo), Johns Hopkins University, Johns Hopkins All Children''s Hospital, Office of Medical Education, St. Petersburg, Fla;1. University of Minnesota, Masonic Children''s Hospital, Pediatric Hospital Medicine (KA Allen), Minneapolis, Minn;2. University of Minnesota, Clinical and Translational Science Institute, Biostatistical Design and Analysis Center (RL Freese), Minneapolis, Minn;3. University of Minnesota School of Medicine & Masonic Children''s Hospital, Pediatric Hospital Medicine (MB Pitt), Minneapolis, Minn;1. Department of Pediatrics (JC Gay), Vanderbilt University Medical Center, Nashville, Tenn;2. Department of Pediatrics (RJ Teufel), Medical University of South Carolina, College of Medicine, Charleston, SC;3. Department of Population Medicine (A Peltz), Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Mass;4. Division of Hospital Medicine and James M. Anderson Center for Healthcare Improvement, Cincinnati Children''s Hospital Medical Center; Department of Pediatrics (KA Auger), University of Cincinnati College of Medicine, Cincinnati, Ohio;5. Children''s Hospital Association (JM Harris), Washington, DC;6. Children''s Hospital Association (M Hall), Lenexa, Kans;7. Division of Emergency Medicine, Boston Children''s Hospital, Department of Pediatrics (MI Neuman), Harvard Medical School, Boston, Mass;8. Department of Pediatrics and Emergency Medicine (HK Simon), Emory University School of Medicine; Children''s Healthcare of Atlanta, Atlanta, Ga;9. Nationwide Children''s Hospital, Columbus, Ohio; Department of Pediatrics, The Ohio State College of Medicine (R Morse), Columbus, Ohio;10. Washington University in St. Louis (P Eghtesady), St. Louis, Mo;11. Office of the Chief Medical Officer (R McClead), Nationwide Children''s Hospital, Columbus, Ohio;12. Division of Hospital Medicine (SS Shah), Cincinnati Children''s Hospital Medical Center, Cincinnati, Ohio;1. Department of Pediatrics (R Linderer, N Srinivasan, and A Schwartz), University of Illinois at Chicago, Ill;2. Department of Medical Education (C Park, A Schwartz, and R Yudkowsky), University of Illinois at Chicago, Ill;3. Department of Anesthesiology (C Park), University of Illinois at Chicago, Ill;4. Simulation and Integrative Learning Institute (C Park), University of Illinois at Chicago, Ill |
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| Abstract: | ObjectiveTo prevent missed cases and standardize care, health systems are beginning to implement EHR-based screens (EHR-CA-S) and clinical decision supports systems (EHR-CA-CDSS) for the identification and management of child maltreatment. This study aimed to 1) document the existing research evidence on the performance of EHR-CA-S and EHR-CA-CDSS and 2) examine clinical perspectives regarding the use of such tools and factors that affect uptake.MethodsWe searched MEDLINE, Embase, EBSCO, Scopus, and CINAHL databases for English language articles published prior to November 2021 that describe and/or evaluated an EHR-CA-S and/or EHR-CA-CDSS involving 0 to 18-year olds. We performed semistructured interviews with 20 individuals who have experience in identifying, evaluating, and/or treating child maltreatment and/or conducting research on these topics.ResultsOur search identified 574 articles; 16 met inclusion criteria. Studies examined screening, alerts and triggers, and quality improvement. None evaluated long-term clinical outcomes. Sensitivity ranged from 0.14 to 1.00, specificity from 0.865 to 1.00, positive predictive value from 0.03 to 1.00 and negative predictive value from 0.55 to 1.00. A variety of EHR-CA-S and/or EHR-CA-CDSS have been implemented at institutions in our sample. Interviewees cited missed cases, policy requirements, and the lack of standardization of care as impetuses for adopting these tools, yet expressed concerns regarding insufficient evidence, bias, and time-intensiveness of implementation.ConclusionsInterviewees and the literature agree that current evidence does not support adoption of a particular CA-S or CA-CDSS. Further refinement and research on EHR-CA-S and EHR-CA-CDSS is necessary for these tools to be feasibly implemented and sustained, reliable for clinical practice, and not cause any unintentional harms. |
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| Keywords: | child abuse |
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