A quality-improvement effort across 33 primary care practices substantially increased screening for chlamydia and gonorrhea among adolescents, according to researchers at Children’s Hospital of Philadelphia.
The initiative combined a pre-visit health questionnaire, electronic health record tools, redesigned clinical workflows and, ultimately, universal opt-out screening for eligible adolescents. The results were published in Pediatrics and reported by Medical Xpress.
The effort is significant because chlamydia and gonorrhea frequently produce no symptoms. Without screening, infections can remain undetected even when testing and treatment could prevent complications and reduce further spread.
Screening gap in adolescent care
Adolescents and young adults have higher infection rates for chlamydia and gonorrhea than other age groups, according to the report. People aged 15 to 24 account for about half of new sexually transmitted infections in the United States.
Yet routine opportunities for identifying infections are often missed. The researchers noted that fewer than one-third of adolescents are asked about sexual activity during well visits. That makes the structure of primary care visits, including who asks questions and how the answers lead to follow-up, important to screening access.
Pediatricians and pediatric care teams are positioned to provide screening and counseling for adolescents. The CHOP program focused on making those services part of a repeatable routine rather than leaving screening solely to an individual clinician’s memory or a patient’s willingness to initiate the discussion.
Building screening into the visit
The initiative was introduced in stages across the 33 CHOP Care Network primary care practices. It began with the Adolescent Health Questionnaire, a pre-visit tool developed and piloted by the Possibilities Project at CHOP.
The questionnaire was designed to prompt conversations about key adolescent-health topics and to help identify patients who might benefit from additional care. In this setting, the information collected before or during a visit could support a more consistent path to screening.
The team then paired the questionnaire with electronic health record best-practice alerts. These alerts brought screening-related information into clinicians’ existing systems rather than relying on separate manual tracking.
Prepopulated order sets were also added. The order sets included next steps that depended on responses to the questionnaire, giving clinicians a structured way to move from identifying a potential need to ordering the appropriate screening.
The program also included financial incentives for physicians who increased screening rates. The intervention therefore combined patient-facing questions, clinical decision support, workflow design and incentives instead of treating screening as a single isolated task.
Team-wide workflow changes
The changes involved more than physicians. Pediatricians, nurse practitioners, nurses, medical assistants, front-desk staff and office staff at all 33 practices redesigned how they cared for adolescent patients.
That broad participation matters because well-visit screening depends on a chain of activity: preparing for the visit, gathering information, prompting a conversation, placing orders, conducting tests and ensuring that follow-up can occur. An electronic prompt by itself cannot guarantee that every part of that process works smoothly.
By making adolescent care a shared practice-level responsibility, the CHOP team sought to reduce the points at which a screening opportunity could be missed. The report describes the project as a feasible approach for incorporating screening into routine well visits.
Opt-out testing produced the largest gains
The final stage was universal opt-out screening. Under that model, all eligible adolescents are tested unless they decline. The researchers reported that the largest screening gains followed this step.
The program was associated with screening reaching 75%, as well as detection of more infections. The finding does not simply reflect a new laboratory test; it reflects a shift in how the health system presents and operationalizes screening during standard primary care.
Opt-out screening changes the default. Instead of requiring a patient or clinician to actively begin the testing process in every case, screening is offered routinely to eligible patients while preserving the option to decline. In a population where infections may be asymptomatic and discussions of sexual health may not occur at every visit, that default can materially affect whether testing happens.
Implications for primary care
The CHOP findings suggest that electronic health record-enabled quality improvement can help primary care practices close gaps in adolescent STI screening. The approach relies on tools that many health systems already use in other settings: questionnaires, alerts, order sets, workflow redesign and performance incentives.
Its broader implication is that screening rates can depend as much on care delivery design as on clinical guidance. When questions are asked consistently, results are connected to next steps and every member of the office has a defined role, routine visits can become more reliable points for preventive care.
The study also highlights the potential value of universal opt-out screening in practices serving adolescents. Because chlamydia and gonorrhea can go unnoticed without testing, detecting more infections may allow treatment to begin earlier and may help limit further transmission.
For primary care organizations, the CHOP initiative offers a model centered on implementation: make screening visible in the record, embed follow-up actions in the workflow, and ensure that the responsibility does not rest with one clinician alone. The reported rise to 75% shows how those connected changes can alter what happens in everyday adolescent care.
This article is based on reporting by Medical Xpress. Read the original article.
Originally published on medicalxpress.com
