1. Increasing Early Childhood Screening in Primary Care Through a Quality Improvement Collaborative
- Author
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Kathryn Janies, Laura DeStigter, Darcy Steinberg, Kori B. Flower, Jennifer Zubler, Tumaini R. Coker, Marian F. Earls, Robert J. Gillespie, Toni M. Whitaker, Sara Massie, Jane Bassewitz, and Michelle M. Macias
- Subjects
Male ,medicine.medical_specialty ,Quality management ,Primary Health Care ,Referral ,business.industry ,MEDLINE ,medicine.disease ,Quality Improvement ,Resource (project management) ,Autism spectrum disorder ,Child, Preschool ,Surveys and Questionnaires ,Family medicine ,Pediatrics, Perinatology and Child Health ,Community health ,medicine ,Humans ,Mass Screening ,Female ,Social determinants of health ,Early childhood ,business ,Intersectoral Collaboration - Abstract
OBJECTIVES: Multiple early childhood screenings are recommended, but gaps persist in implementation. Our aim for this project was to improve screening, discussion, referral, and follow-up of development, autism spectrum disorder (ASD), maternal depression, and social determinants of health (SDoH) to 90% by July 2018. METHODS: This 1-year national quality improvement collaborative involved 19 pediatric primary care practices. Supported by virtual and in-person learning opportunities, practice teams implemented changes to early childhood screening. Monthly chart reviews were used to assess screening, discussion, referral, and follow-up for development, ASD, maternal depression, and SDoH. Parent surveys were used to assess parent-reported screening and referral and/or resource provision. Practice self-ratings and team surveys were used to assess practice-level changes. RESULTS: Participating practices included independent, academic, hospital-affiliated, and multispecialty group practices and community health centers in 12 states. The collaborative met development and ASD screening goals of >90%. Largest increases in screening occurred for maternal depression (27% to 87%; +222%; P < .001) and SDoH (26% to 76%; +231%; P < .001). Statistically significant increases in discussion of results occurred for all screening areas. For referral, significant increases were seen for development (53% to 86%; P < .001) and maternal depression (23% to 100%; P = .008). Parents also reported increased screening and referral and/or resource provision. Practice-level changes included improved systems to support screening. CONCLUSIONS: Practices successfully implemented multiple screenings and demonstrated improvement in subsequent discussion, referral, and follow-up steps. Continued advocacy for adequate resources to support referral and follow-up is needed to translate increased screening into improved health outcomes.
- Published
- 2020