Linking of Child Welfare and Electronic Health records to Improve Health for Foster Youth

Faculty members Sarah Beal, PhD, of the Division of Behavioral Medicine and Clinical Psychology; Mary Greiner, MD, MS, of the Division of General and Community Pediatrics; and Judith Dexheimer, PhD, of the Divisions of Emergency Medicine and Biomedical Informatics, worked with a larger research team spanning Cincinnati Children's Hospital Medical Center and Hamilton County Job and Family Services to link records from Hamilton County’s child welfare administrative database and Cincinnati Children's electronic health record to support near real-time information exchange between child welfare caseworkers and Cincinnati Children's providers in a web portal called Integrated Data Environment to eNhance ouTcomes In cusTody Youth (IDENTITY). Now in place for the 2100 children in protective custody in Hamilton County, all caseworkers have access to immunization records, upcoming appointments, and medications and diagnoses for children in their custody. Cincinnati Children's now has access to custody and legal status, caseworker and caregiver contact information, and Medicaid billing numbers, which are frequently missing or out of date in Epic. Funded by grants from Cincinnati Children's, the Kettering Foundation, and the National Library of Medicine, the National Institute on Minority Health and Health Disparities, and the National Institute on Drug Abuse at the National Institutes of Health, this research team is expanding efforts to identify and intervene at points of high-risk for children in custody, including at the time of a change in living arrangement or with emancipation from protective custody. Improved data sharing with community partners through IDENTITY is a critical step towards this goal.

Evaluation of Electronic Adherence Monitoring Devices

Drs. Meghan McGrady, PhD, and Rachelle Ramsey, PhD, along with faculty and fellows in the Center for Adherence and Self-Management at Cincinnati Children’s, conducted the first independent evaluation of electronic adherence monitoring devices (EAMDs). The team conducted a comprehensive literature review and contacted the manufacturers of all commercially-available EAMDs. Using a standardized protocol, the team assessed the accuracy of ten EAMDs and documented features relevant to usability including capacity, data transmission method, and reminder functions. The results were recently published in the Annals of Internal Medicine and provide clinicians and researchers with a guide for selecting the optimal electronic adherence monitoring device.

Successful Integration of a Psychological Screening Process into Medical Care for Youth with Abdominal Pain: A Quality Improvement Initiative

In a study funded by the American Pain Society Sharon S. Keller Chronic Pain Research Grant and the Cincinnati Children’s Place Outcomes Research Award, Dr. Natoshia Cunningham, and colleagues, led a quality improvement initiative to integrate psychological screening into pediatric gastroenterology practices for youth presenting with abdominal pain. The secondary goal of this project was to devise a systematic and tailored approach to treatment based on the screening results. In the first six months, the study screened a total of 1,291 patients. Using quality improvement methods overall screening rates increased from <1% of >80%, and maintained these rates after the formal completion of the project. Clinical cut-points on measures of anxiety, disability due to pain, and pain intensity guided a systematic approach to care. Overall, 21% of youth had clinical elevations in all three domains. In such instances, medical providers received an automated prompt in the EMR to tailor care, including to consider a psychological referral for cognitive behavioral therapy for pain and anxiety. Following the project implementation, psychological referral rates increased from 8.3 per 1,000 patients to 15.2 per 1,000 patients overall. Furthermore, there was a three-fold increase in psychological referral rates in instances where a provider received an automated prompt to consider a psychological referral. Future directions of this work include improving access to psychological care for at-risk youth with abdominal pain. In line with her current NIH K23 award, Dr. Cunningham is currently testing a tailored psychological treatment she developed for youth with abdominal pain and co-occurring anxiety. This approach includes a blend of in-person sessions and web-based components, which may reduce face-to-face time needed with a psychological provider and increase access to care. The results of the quality improvement study were recently published in Pediatrics and featured in Reuters Health/Medscape.