490 - Addressing ACEs by integrating a parenting assessment into pediatric primary care: time, costs, and impact on a practice’s finances

Poster Number: 490
Publication Number: 490.344

Victoria N. Lawson, Vanderbilt University School of Medicine, Nashville, TN, United States; Anna Whitney, Vanderbilt University School of Medicine, Nashville, TN, United States; Amber Cooke, Vanderbilt University School of Medicine, Nashville, TN, United States; Kathryn Carlson, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, United States; Merrill M. Stoppelbein, Vanderbilt University School of Medicine, Nashville, TN, United States; Laura A. Jana, Penn State University, Omaha, NE, United States; Jacqueline Antoun, Vanderbilt University School of Medicine, Nashville, TN, United States; Seth J. Scholer, Vanderbilt University School of Medicine, Nashville, TN, United States

Background: The cost of adverse childhood experiences (ACEs) to society in the U.S. is estimated at hundreds of billions of dollars per year. Some ACEs are negative parenting practices (e.g. spanking). Pediatricians are motivated to intervene for unhealthy parenting, but hurdles include time constraints and lack of reimbursement. Time and costs to integrate a parenting assessment are unknown.

Objective: To estimate the time, costs, and impact on a practice’s finances to integrate a validated parenting assessment tool into the well child visit.

Design/Methods: The Quick Parenting Assessment (QPA) is a validated, 13 item ACEs screening tool that assesses for healthy and unhealthy parenting practices. Elevated QPAs ( >2) are associated with an increased likelihood of childhood behavior problems which are considered an early manifestation of exposure to toxic stress. In a clinic serving low-income parents, the QPA was integrated into the 15 month, 30 month, 5 year, and 8 year well child visits. Health care providers were educated about how to review the QPA with parents with a 20-minute presentation. After a QPA encounter, providers were invited to complete a one-page survey about the QPA review process (Nf399). Key measures were the QPA score and providers’ estimate of time required to review the QPA with parents. We estimated the range of costs of QPA integration and the impact of QPA integration on a practice’s finances.

Results: Health care providers reported that they reviewed the QPA with 86% (342/399) of parents. Of the QPAs that were reviewed, 79% (Nf269) were low risk (QPA < = 2) and 21% (Nf73) were elevated risk (QPA > 2). Most providers reported that low risk QPAs were reviewed in < = 1 minute and high risk QPAs in < = 2 minutes. The range of cost was $1 to $6 per parenting assessment depending upon two key variables, cost of provider time and the QPA score (Table 1). The impact of the QPA on a pediatric practice’s finances varies depending upon the integration method (Table 2). If billed as a patient-focused health risk assessment, QPA implementation could lead to increased practice revenue (Table 2).Conclusion(s): An ACEs screening instrument, focused on parenting, can be integrated into pediatric primary care relatively efficiently and inexpensively. The potential for health care providers to bill and be reimbursed for the QPA as a patient-focused health risk assessment could further incentivize them to routinely address parenting as part of the well child visit. These findings have implications for improving pediatric primary care, preventative and value-based care, and mitigating ACEs.
Table 1: Time and cost estimates to administer the Quick Parenting Assessment (QPA) in clinic.
Table 2: Method of integrating the Quick Parenting Assessment (QPA) and the likely impact on a pediatric practice’s finances.