PHYSICIANS DOCUMENTATION OF SEXUAL ABUSE OF CHILDREN

Objectives: To assess the quality of documentation by physicians in th eir evaluations for sexual abuse of children and to define factors tha t affect documentation. Design: Cross-sectional survey and blinded cha rt review. Setting: A statewide program for child abuse evaluations. P articipants: Physicians (n=145) who performed evaluations during fisca l year 1992-1993 were surveyed. Up to five randomly chosen medical rec ords (n=548), obtained from each eligible physician, were reviewed. In terventions: None. Measurements and Results: A survey of physicians wh o participated in the statewide program was made in summer 1993, with 78% participation. Knowledge scores were derived from the survey based on a comparison with the responses of a panel of five experts. Charts that were obtained from eligible physicians were assessed by two blin ded reviewers. Documentation of the history and physical examination w as evaluated as good or excellent by 30% and 23% of the physicians, re spectively. Factors that were positively associated with better docume ntation of the history included a more structured format for the recor d, continuing medical education courses on sexual abuse of children, f emale gender, and a history of disclosure (P<.005 for all). Factors th at were related to good documentation of the physical examination incl uded structured records, continuing medical education courses, female gender, and knowledge scores. Factors that were not related to knowled ge or documentation included the number of evaluations performed, prac tice group size or location, age of the physician, and a physician's r eading of journal articles about sexual abuse of children. Conclusion: Quality of evaluations for sexual abuse of children may be improved b y the use of structured records and participation in continuing medica l education courses with regard to sexual abuse of children.