Using Maintenance of Certification as a Tool to Improve the Delivery of Confidential Care for Adolescent Patients

J Pediatr Adolesc Gynecol. 2017 Feb;30(1):76-81. doi: 10.1016/j.jpag.2016.08.006. Epub 2016 Aug 16.


Study objective: Providing adolescents with confidential health care results in better social and health outcomes. We sought to assess if a medical board Maintenance of Certification Part IV project could improve the delivery of confidential care to minor adolescent patients seen in outpatient primary care practices.

Design: Participating physicians reviewed 3 months of charts for patients ages 12-17 years seen for well visits during a baseline time period, and after 2 Plan, Do, Study, Act intervention cycles to assess if they had met confidentiality standards. Participating physicians additionally completed an assessment tool on personal and clinic practices related to confidentiality.

Setting: Nine academic and 3 private practice family medicine, pediatrics, and medicine-pediatrics sites.

Participants: Forty-four physicians.

Interventions: Provider and staff deficits in knowledge of minor consent laws, resistance toward the idea of confidential care, and work flow issues around confidential screening were identified as primary barriers. Staff and provider trainings, scripts, and staff involvement in planning work flows were identified as key interventions.

Main outcome measures: Improvement in confidentiality standards met during minor adolescent well visits.

Results: Participating physicians significantly increased the proportion of well visits in which they spent time alone with the patient (P = .001), explained minor consent laws (P < .001), and had the adolescent complete a confidential risk screening tool (P < .001), in addition to improving scores on their confidentiality assessment overall (P < .001).

Conclusions: A medical board Maintenance of Certification Part IV project is an effective way to change physician practice and improve the delivery of confidential care to minor adolescents seen for well visits.

Keywords: Adolescent health services; Confidentiality; Informed consent by minors; Maintenance of certification; Privacy; Quality improvement.

MeSH terms

  • Adolescent
  • Adolescent Health Services / standards*
  • Adult
  • Ambulatory Care Facilities / standards
  • Certification / standards*
  • Child
  • Confidentiality / standards*
  • Family Practice / standards*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Primary Health Care / standards*