556 - Pediatricians' Practice Of Collecting Educational Records Of Patients With ADHD In The Electronic Health Record

Poster Number: 556
Publication Number: 556.108

Nicole M. Garton, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States; Katherine Tennant. Beenen, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States; Theresa McGoff, Western Michigan University Homer Stryker M.D. School of Medicine, Plainwell, MI, United States; Emily Carroll, Western Michigan University Homer Stryker M.D. School of Medicine, Longmeadow, MA, United States; Ashley Tang, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States; Kevin Lee, Western Michigan University, Kalamazoo, MI, United States; Neelkamal Soares, Western Mich Univ Homer Stryker MD Sch of Medicine, Kalamazoo, MI, United States

Background: In treating Attention Deficit Hyperactivity Disorder (ADHD), the American Academy of Pediatrics advises primary care pediatricians (PCPs) to consider (depending on patient age) Federal Drug Administration (FDA)-approved medication, behavior management, and/or classroom environmental interventions. PCPs may use educational records in the initial diagnosis of ADHD and progress monitoring.   While electronic health record (EHR) data has been mined for PCP prescribing practices and behavior therapy recommendations, less is known about educational advocacy, including the frequency with which PCPs obtain copies of educational records for youth with ADHD. 

Objective: To determine the extent to which PCPs collect educational records from their patients with ADHD and how these records are labeled within the EHR.

Design/Methods: A retrospective chart review over an 18-month timeframe was conducted for children and adolescents, ages 6-18 years with an ADHD diagnosis, including demographic characteristics, medication, and select comorbid diagnoses. We manually screened all scanned documents in each patient’s chart for educational records and their labels. We used multivariable logistic regression models to determine patient factors associated with having at least one document scanned into the EHR. We also calculated the odds ratios (OR) and their 95% confidence intervals (CI). Analyses were conducted using R software (version 4.0.0). 

Results: 314 unique patients had 1,459 ADHD-related visits, with a mean of 4.6 (SD = 2.4) visits. Mean age was 11.2 years (+/- 3.4 years), patients were mostly male (69.7%) and covered by public insurance (76.4%). About 90% were prescribed ADHD medication, 64.3% had seen a behavioral health specialist (psychologist or developmental-behavioral pediatrician) at our institution, and 13.4% had at least one comorbid diagnosis. Only 13% of patients had at least one educational record scanned into the EHR; engagement with a specialist and one unit decrease in age increased the likelihood of having an educational record scanned (p < 0.05). Other patient factors are not statistically significant. Almost half (48%) of the scanned records were incorrectly labeled. 

Conclusion(s): PCPs do not often obtain educational records for most patients, though involvement of behavioral health specialists did increase the likelihood that records were obtained, and more than half of records were incorrectly labelled. Barriers to obtaining and locating educational records in the EHR need to be addressed for PCPs to optimize the care of pediatric patients with ADHD.