Document Type


Publication Date



Maine Medical Center, Medical Education, Maine Medical Center Research Institute, Family Medicine

MeSH Headings

Humans, Adolescent, Quality Improvement, Confidentiality, Adolescent Health Services


Purpose/Background: Spending time alone with adolescents during routine clinic visits is considered the standard of care. One-on-one time facilitates the development of adolescents’ abilities to manage their own health concerns and also increases physician-adolescent communication about sensitive health topics. Despite this, recent studies suggest that up to 60% of adolescents do not get the opportunity to spend time alone with their provider.

In collaboration with other practitioners led by a national faculty panel from the American Academy of Pediatrics and the Society for Adolescent Health and Medicine, we developed a quality improvement project that aimed to review this aspect of adolescent healthcare within the Portland Family Medicine Clinic. We aimed to improve the quality of preventive services delivered to adolescents and young adults by increasing the delivery of private, confidential healthcare through improved documentation. We predicted improvement in the documentation, and provision of, this service when providers are prompted to document this within the well-child check (WCC) note template, thereby improving the quality of confidential care of adolescents within our clinic.

Methods/Approach: Our project utilized a “Plan-do-study-act” model. We studied adolescent and young adults (ages 13-26) who were seen for WCC by eight providers on one clinical team at the Portland Family Medicine Clinic. Baseline data were collected through chart reviews of twenty adolescents who were seen for WCC in March 2019. Data included whether there was documentation that adolescents were given access to alone time with their provider, if confidentiality was discussed, and if adolescents were screened for sexual activity, mental health concerns and substance use. We used serial PDSA cycles to test the following changes: prompting providers in the visit note template to document alone time (cycle 1), adding an additional prompt to document who was present at the visit (cycle 2), and adding a third prompt to document screening for sexual activity (cycle 3). We tracked the rates of documentation of these metrics. There was a total of 21 adolescent patients included in cycle 1, 15 in cycle 2 and 10 in cycle 3.

Results: Baseline data obtained from chart reviews of adolescent patients showed that our providers were documenting spending “alone time” with adolescents 0% of the time. After the first PDSA cycle, documentation of “alone time” improved to 95.2%. Baseline data also showed that providers were discussing confidential healthcare with adolescents 0% of the time. Documentation of confidentiality improved to 38.1% after PDSA cycle 1 and 46.7% after PDSA cycle 2. Baseline data showed that adolescent patients were screened for sexual activity 33.3% of the time. This improved to 100% after completion of PDSA cycle 3.

Conclusions: Prompting providers to document provision of one-on-one time and discussion of confidentiality with adolescent patients improves the delivery of quality of adolescent care.


2020 Costas T. Lambrew Research Retreat