Original article
Variability in Sexual History Documentation in a Primary Care Electronic Health Record System

https://doi.org/10.1016/j.jadohealth.2021.10.001Get rights and content

Abstract

Purpose

We sought to evaluate sexual history documentation and corresponding Chlamydia trachomatis screening practices across a large pediatric primary care network in the context of patient and clinic characteristics.

Methods

Demographic, chlamydia screening, and provider note data were collected via electronic health record and manual chart audit for females aged 15-19 years attending annual well-adolescent visits, from February 1 to 28, 2019. Inductive qualitative textual analysis evaluated sexual history documentation as informative (containing clear indication of patient as sexually active or not) or noninformative and identified documentation subtypes. We examined patient and clinic characteristics by sexual history documentation type (informative or noninformative) and chlamydia screening status and documentation subtypes across clinic types using chi-square and Fisher’s exact tests. A multilevel logistic regression model considering clinic-specific random effects evaluated predictors of informative sexual history documentation.

Results

Chart notes were examined for 1,062 patients across 31 unique clinics. Only 34.7% of chart notes were found to have informative sexual history documentation. Older patients (odds ratio: 1.51, 95% confidence interval: 0.99-2.31) and patients seen at clinics receiving U.S. Department of Health and Human Services Title-X funding (odds ratio: 11.05, 95% confidence interval: 1.34-90.86) had higher rates of informative documentation. The overall Chlamydia screening rate was 13.1%.

Conclusion

Sexual history documentation varied widely across clinics, and the majority of chart notes were found to have noninformative documentation. Understanding and addressing barriers to informative sexual history documentation and comprehensive sexual health care is fundamental to improve adolescent sexual health outcomes, particularly given recently enacted federal electronic health record transparency policies.

Section snippets

Setting

This cross-sectional study used the EHR system used across a 31-clinic academic pediatric primary care network. The network had a chlamydia test positivity rate of 12.9% across the period of 2015–2019 [19].

Eligibility and data collection

This analysis consisted of EHR review and manual chart audit. Female patients aged 15–19 years who attended an annual preventative care well-child visit between February 1, 2019, and February 28, 2019, were eligible. As part of an existing quality improvement intervention to improve Chlamydia

Demographic characteristics

Charts were identified for 1,075 patients seen during the study window. Notes for 13 patients (1.2%) were not visible owing to “sensitive note” restrictions and were therefore excluded. Chart notes were audited for the remaining 1,062 patients seen during the study window. Demographic characteristics stratified by informative versus noninformative sexual history documentation are displayed in Table 1. Most of the patients were privately insured, White, non-Hispanic/non-Latinx, and seen at

Discussion

Our analysis reveals high variability in sexual history documentation across a large pediatric primary care network consisting of both urban and suburban clinics with distinct patient populations. We examined the informational quality and the type of sexual history documentation in the context of clinic and patient population characteristics. Only approximately one-third of all the chart notes provided informative sexual history documentation. Our multivariate analysis revealed that patients

Acknowledgments

The authors would like to thank Haley Richardson for her assistance with data analysis and manuscript preparation.

References (40)

  • K.A. Workowski et al.

    Sexually transmitted diseases treatment guidelines, 2015

    MMWR Recomm Rep

    (2015)
  • M.L. LeFevre

    Screening for Chlamydia and gonorrhea: U.S. Preventive services Task Force recommendation statement

    Ann Intern Med

    (2014)
  • C.L. Shannon et al.

    The growing epidemic of sexually transmitted infections in adolescents: A neglected population

    Curr Opin Pediatr

    (2018)

  • Youth risk behavior survey - United States, 2019

  • E.D. Berlan et al.

    Variations in measurement of sexual activity based on EHR definitions

    Pediatrics

    (2014)

  • 1991-2017 High school Youth risk behavior survey data

  • Chlamydia screening in women

  • 2019 quality rating system HEDIS Value Set directory

  • G. Tao et al.

    Understanding sexual activity and Chlamydia testing rate based on linked national survey and Medicaid claims data

    PLoS One

    (2015)

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    Conflict of interest: The author group has no conflicts of interest to disclose.

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