O3198: Quantifying Patient Questionnaire Fatigue in Pediatric Primary Care

Background: Pre-visit questionnaires serve a critical purpose in optimizing the patient-doctor interaction in pediatric primary care. Such questionnaires can serve many functions, including soliciting patients’ priorities, monitoring condition-specific symptoms, or performing critical screening for medical or social needs or developmental surveillance. Implementing questionnaires through an electronic patient portal offers a convenient way to gather this information ahead of the visit in a format that integrates with the Electronic Health Record (EHR). However, these benefits must be balanced with the burden that comes with additional electronic forms. Along those lines, we sought to quantify pre-visit “questionnaire fatigue” by measuring how questionnaire completion rates vary with each subsequently presented pre-visit survey within a large pediatric primary care network.

Methods: The following study was performed in a large pediatric primary care network in Massachusetts, which includes ~80 practices and ~600 providers. Patient portal pre-visit questionnaire completion was analyzed for preventive visits occurring in the network during 2023 for patients under age 13 years. Patients over 13 years old were excluded because our portal is configured such that for adolescents patients, pre-visit questionnaires are sent directly to the patient’s portal account as opposed to the parent/guardian proxy account. To understand whether there is a change in completion rate with each subsequently presented questionnaire, completion rate (with 95% confidence intervals) was calculated against the order in which the questionnaire was presented in the patient portal. How many and which pre-visit questionnaires are assigned ahead of a well child visit varies and is dictated by the patient’s age (e.g. relevant developmental screens) and the presence of any chronic conditions (such as asthma).

Results: A total of 1,461,990 questionnaires across 319,334 encounters involving 211,376 patients were analyzed. The overall questionnaire completion rate was 49%. Pre-visit questionnaire completion rate remained mostly steady across the first three presented questionnaires. However, following the third questionnaire, a clear drop in completion rate was observed, resulting in an approximately 5% decrease with each subsequent questionnaire (Figure).

Conclusion: Our analysis demonstrates a steady decline in pre-visit questionnaire completion rates with each subsequently assigned questionnaire, occurring most notably after the third one. This measure can be used to quantify “questionnaire fatigue” on the part of the patient’s proxy. Recognizing and measuring this phenomenon can inform efforts to prioritize more important pre-visit surveys, by either limiting the number of assigned questionnaires or presenting them in order of most to least important. For example, in our EHR system, the order in which questionnaires are presented in the patient portal is dictated primarily by the questionnaire’s internal identifier (called a “record ID”) assigned by the EHR system at the time the questionnaire is built, rather than intentional choices made by clinicians.