The more you know: Insights from integrated pre-visit surveys in a pediatric environmental health center

Our plain-English summary of The more you know: Insights from integrated pre-visit surveys in a pediatric environmental health center, by S.H. Shah, A.D. Woolf, K. Manning, et al (International Public Health Journal, 2023).

The study

• Authors: S.H. Shah, A.D. Woolf, K. Manning, F. Holder-Niles, B. Tully, S. Flanagan, M.C. Spence, M. Hauptman
• Journal: International Public Health Journal
• Published: 2023;15(3):297-306
• Cited by: 1 article, as counted by NIH iCite
• Read it: PubMed · Free full text

Abstract

The Pediatric Environmental Health Center (PEHC) at Boston Children's Hospital is a specialty referral clinic that provides consultation for approximately 250 patients annually. Identifying environmental hazards is key for clinical management. Exposure concerns include lead, mold, pesticides, perfluoroalkyl substances (PFAS), impaired air quality, and more. Our goal was to identify concerns and visit priorities of our patient population to guide visits. A 47-question pre-visit survey was created exploring potential environmental hazards and administered prior to visits using a platform integrated into the electronic medical record (EMR). The study group was a convenience sample of patients from June 2021 to June 2022. Of 204 total visits, 101 surveys were submitted, yielding a response rate of 49.5%. 66/101 (65.3%) were surveys from initial consultations used for descriptive analysis. The majority of patients were seen for a chief complaint of lead exposure (90.1%). Most respondents had concerns about peeling paint (40.0%), and those reporting peeling paint were more likely to report additional concerns [75.0%, p < 0.001]. Other concerns highlighted were mold (15.2%), pests (15.2%), asbestos (10.6%), air pollution (9.1%), temperature regulation (7.6%), pesticides (6.1%), PFAS (4.5%), and formaldehyde (4.5%). A knowledge gap was identified; 45.5% (30/66) respondents responded "no" to the question asking if the Poison Control Center phone number was stored in their phone. This study illustrates how the implementation of a pre-visit EMR integrated survey engages families, informs clinical care, and serves as a point-of-care education tool for specific knowledge gaps. Findings will guide development of future environmental health screeners.

In plain English

This study described answers to a 47-question environmental survey. Families received it by email before visits to the Pediatric Environmental Health Center at Boston Children's Hospital between June 18, 2021 and June 18, 2022. Of 204 visits, 101 surveys were completed, a response rate of 49.5%. The 66 surveys from first visits were analyzed with descriptive statistics. Most of these patients (60 of 66) were referred for lead exposure. The concerns families reported were peeling paint (24 of 66), mold (10 of 66), pests (10 of 66), asbestos (7 of 66, 10.6%) and air pollution (6 of 66), among others. These were concerns families reported, not measured exposures. Of families reporting peeling paint, 18 of 24 (75.0%) also reported other environmental concerns (p less than 0.001). Thirty of 66 (45.5%) said the Poison Control Center number was not stored in their phone. The authors concluded the survey helped engage families and direct guidance. They noted that it came from one specialty clinic, used a convenience sample, and was offered only in English.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Descriptive analysis of responses to a pre-visit environmental health survey built into the electronic medical record
• Who was studied: A convenience sample of patients scheduled at the Pediatric Environmental Health Center, Boston Children's Hospital, from June 18, 2021 to June 18, 2022. There were 204 visits and 101 surveys completed, of which 66 surveys from initial visits were analyzed. Respondents lived in 37 towns in Massachusetts and two in Rhode Island.
• Exposure: Family-reported home environmental concerns asked about in a 47-question survey, including peeling paint and lead, mold, pests, asbestos, air pollution, temperature regulation, pesticides, PFAS and formaldehyde. No asbestos fiber type or measured exposure was reported.
• Main results:
  • 101 of 204 visits had a completed survey, a response rate of 49.5%. 66 of the 101 (65.3%) were from unique patients or initial visits.
  • Among the 66 analyzed patients, 60 (90.9%) had a chief complaint of lead exposure.
  • Concerns reported among the 66 respondents: peeling paint (printed as 40.0%, 24/66), mold (15.2%, 10/66), pests (15.2%, 10/66), asbestos (10.6%, 7/66), air pollution (9.1%, 6/66).
  • Among respondents reporting peeling paint, 18 of 24 (75.0%) also reported additional environmental concerns (p less than 0.001).
  • Respondents who did not report peeling paint concerns were more likely to have a lead-related chief complaint (p printed as less than 0.012).
  • 44 of 66 respondents (66.7%) reported a lead inspection of their home. Of those, 41 of 44 (93.2%) reported that hazards were identified.
  • 30 of 66 respondents (45.5%) answered no when asked whether the Poison Control Center number was stored in their phone.
• The authors' conclusion: The authors concluded that the pre-visit electronic survey helped engage families before visits, helped direct guidance to the concerns families identified, and served as a point-of-care education tool.
• Limitations the authors state:
  • Generalizability is limited by the convenience sample drawn from a single specialty clinic at a large academic center.
  • The response rate and the share of families reporting concerns may have been influenced by this being a specialty clinic.
  • The survey was offered only in English and may not capture the needs of non-English-speaking families.
  • Follow-up visit surveys were excluded, which could underestimate hazards if new concerns arose at follow-up.
  • Families' denial of hazards may reflect limited environmental health literacy or awareness.
  • The length of the survey may be an obstacle to family completion and to provider review.

Related studies

• Environmental health centers for asbestos and their health impact surveys and activities — D.M. Kang, J.E. Kim, et al. (2016)
• What every physician should know about environmental health — C. Carlsten, J. Croke (1997)
• Environmental pollution and extreme weather conditions: insights into the effect on mental health — M. Tota, J. Karska, et al. (2024)
• Health and environmental consequences of the world trade center disaster — P.J. Landrigan, P.J. Lioy, et al. (2004)
• Emergency diagnosis of cancer and previous general practice consultations: insights from linked patient survey data — G.A. Abel, S.C. Mendonca, et al. (2017)
• Survey and biological insights of pemetrexed-related therapeutic improvement in mesothelioma: The Nancy Centre of Biological Resources' Mesothelioma Cohort — F. Vlastos, G. Hillas, et al. (2009)

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