Background: For children who arrive as refugees, the healthcare system can be overwhelming. Appropriate management of the unique medical, developmental, and psychosocial needs in refugee populations requires coordination of multiple care providers and proper handling of incoming information. Guidance for refugee care differs from standard well childcare in many ways. Often, it can require tasks be completed prior to seeing a child in the office. Many of these tasks could be made more efficient through properly designed clinical decision support (CDS). Objective: To understand the personnel and workflows of refugee child visits as a basis for developing CDS to improve efficiency and adherence to guideline recommendations for refugee healthcare. Methods: Three members of the CDS development team performed an in person observation of a typical refugee session within our pediatric care center and collected documentation used to support these visits (e.g. pre-arrival exams). We categorized members of the healthcare team into user roles, identified the workflows required to complete refugee healthcare encounters, and inventoried the CDS elements utilized within each of these workflows. User roles were mapped to tasks within each workflow in order to identify the key actors for given workflows. We identified differences between refugee healthcare and standard well childcare in user roles, workflows, and CDS utilization. Result: We identified four user roles that were distinctive to refugee care (Table 1). These included: Agency Coordinator, Refugee Care Coordinator, Pre-visit Clinician, and Interpreter. Each of these user roles is responsible for completing tasks that are wither unique to refugee care. Successful completion of a refugee visit involved the completion of up to 11 clinical workflows. Workflows that differed from traditional well child visits included registration, first visit scheduling, rooming, vaccination planning, follow up planning, and encounter form preparation. CDS for standard well visits poorly supported these activities for refugee care. Workflows unique to refugee care included obtaining pre-visit documentation and the pre-visit laboratory evaluation (Figure 1). Decision support needs included refugee specific order sets, documentation templates, letter templates, and a unique ICD-10 code for refugee care visits. Conclusions: Refugee healthcare involves multiple healthcare representatives filling clearly identifiable user roles. The workflows required to complete refugee visits are complex and differ from traditional well childcare. Development of CDS specific to refugee visits could provide greater benefit to this population and potentially improve healthcare efficiency.
Who Welcomes Kids: A User Role and Workflow Analysis of Refugee Care Visits within an Academic Pediatric Care Center
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Evan Orenstein, Katherine Yun, Dean Karavite, Jeremy J. Michel; Who Welcomes Kids: A User Role and Workflow Analysis of Refugee Care Visits within an Academic Pediatric Care Center. Pediatrics May 2018; 142 (1_MeetingAbstract): 522. 10.1542/peds.142.1MA6.522
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