JMIR Publications

ABSTRACT

Background:

Socioeconomically-disadvantaged newborns receive care from primary-ambulatory-care providers (PCPs) and Women, Infant and Children (WIC) Nutritionists; however, care is not coordinated between these settings, which can result in conflicting messages. Previous studies have shown these stakeholders support an integrated approach that coordinates services between settings with care tailored to patient-centered needs.

Objective:

This analysis describes the usability of advanced health information technologies aimed to engage parents in self-reporting of parenting practices, integrate data into electronic health records to inform and facilitate documentation of provided responsive parenting (RP) care, and share data between settings to create opportunities to coordinate care between PCPs and WIC Nutritionists.

Methods:

Parents and newborns (dyads) who were WIC-eligible and received pediatric care in a single health system were recruited and randomized to a RP intervention or control group. For the intervention, electronic systems were created to facilitate data collection, documentation, data sharing, and coordination of provided RP care. Prior to PCP visits, parents were prompted to respond to the Early Healthy Lifestyles (EHL) self-assessment tool to capture current RP practices. Responses were integrated into the electronic health record and shared with WIC. Documentation of RP care and an 80-character, free-text comment were shared between WIC and PCP to inform and coordinate patient-centered care. A care coordination opportunity existed when the dyad attended a WIC visit and these data were available from the PCP, and vice versa. Care coordination was demonstrated when WIC or PCPs interacted with data and documented RP care provided at the visit. The bi-directional system was active for 6 months. Data sharing and coordination were independently coded by two study-team members for intervention dyads. Means and standard deviations are reported.

Results:

Dyads (N=131) attended 459 PCP (3.5±1.0/dyad) and 296 WIC visits (2.3±1.0/dyad). Parents completed the EHL tool prior to 53.2% of PCP visits (1.9±1.2/dyad); PCPs documented provided RP care at 35.3% of visits; and data were shared with WIC following 100% of PCP visits. A WIC visit followed a PCP visit 50.5% of the time; thus, there were 1.8±0.8/dyad PCP to WIC care coordination opportunities. WIC coordinated care by documenting RP care at 66.7% of opportunities (1.2±0.9/dyad). WIC visits were followed by a PCP visit 58.8% of the time; thus, there were 0.9±0.8/dyad WIC to PCP care coordination opportunities. PCPs coordinated care by documenting RP care at 43.9% of opportunities (0.4±0.6/dyad).

Conclusions:

Results support the usability of advanced health information technology strategies to collect patient-reported data and share these data between multiple providers. Although PCPs and WIC shared data, WIC Nutritionists were more likely to use data and document RP care to coordinate care than PCPs. Variability in timing, sequence and frequency of visits underscores the need for flexibility in pragmatic studies. Clinical Trial: https://clinicaltrials.gov/ct2/show/NCT03482908. Registered March 29, 2018