Implementation of Electronic Health Screening in Primary Care to Improve STI Testing

Adolescents bear a disproportionate burden of the sexually transmitted infections (STIs) gonorrhea, chlamydia, and HIV, with the incidence of infections continuing to rise. The Centers for Disease Control and Prevention (CDC) recommends yearly testing for these infections in all sexually active females as well as men from high-risk populations, or men who have sex with men. However, many pediatricians do not adhere to these recommendations.

The investigators adapted the CDC’s recommendations for use in the emergency department (ED) and for electronic completion by the patient. This tool, called the Electronic STI Risk Assessment (E-STIRA), utilizes an audio-enhanced and computer-assisted self-interview to obtain a sexual history from all patients 15-21 years old who are receiving care in the St. Louis Children’s Hospital ED. An electronic health record-integrated clinical decision support (CDS) tool uses questionnaire results to provide patients and clinicians with recommendations regarding the patient’s need for STI testing. In this current research, the investigators will adapt the E-STIRA CDS tool for use in the pediatric primary care setting.

The specific aims of this study are as follows:

• Adapt the E-STIRA tool and clinical workflows for successful scale up in pediatric clinics. 
• Implement the E-STIRA tool in four pediatric clinics and assess for changes in STI testing and treatment. 

The study will take place at four primary care practices, representing different geographic locations and patient populations. The investigators will adapt E-STIRA based on contextual constraints for use in the pediatric primary care setting, and implement it to increase the evaluation of risky sexual behaviors and detection of STIs.

The investigators will use the Contextualized Technology Adaptation Process and the Consolidated Framework for Implementation Research for optimal implementation and to identify the necessary adaptations to E-STIRA for successful implementation in pediatric clinical settings. They will then evaluate the impact of the tool in the clinics by the number of survey completions by patients and reviews by physicians, as well as increased screening, testing, and treatment of STIs.

Ultimately, the investigators hope that the study will yield knowledge that will improve their ability to reduce the high rate of STIs in the adolescent population, and improve use of technologies to provide clinical care.