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Improving adolescent preventive services through state, managed care, and community partnerships
Jonathan D Klein1, Tracy S Sesselberg, Beth Gawronski
1Division of Adolescent Medicine, Strong Children's Research Center, University of Rochester, 601 Elmwood Avenue, Box 690, Rochester, NY 14642, USA.
Summary
A quality improvement initiative successfully enhanced adolescent preventive care, particularly for Medicaid populations. Academic detailing proved effective in promoting screenings for tobacco, substance use, and HIV prevention.
Area of Science:
- Public Health
- Preventive Medicine
- Healthcare Quality Improvement
Background:
- Adolescent preventive care is crucial for long-term health outcomes.
- Guideline-based initiatives are essential for improving healthcare delivery.
- Consistent screening and counseling for key health risks are often underutilized in adolescent care.
Purpose of the Study:
- To develop and evaluate a multifaceted, guideline-based program aimed at enhancing the quality of preventive care for adolescents.
- To assess the impact of educational interventions and practice support on the delivery of adolescent preventive services.
Main Methods:
- A multipronged approach including continuing education sessions (grand rounds, community rounds) for primary care clinicians.
- Academic detailing involving nurse reviewers conducting chart reviews to promote adolescent-specific confidentiality and screening tools.
- Partnerships with community leaders to raise awareness of quality preventive services.
- Evaluation through comparative chart reviews (2000 vs. 2001) focusing on tobacco, substance use, and HIV prevention screening and counseling rates.
Main Results:
- 285 clinicians attended continuing education sessions, and 96 offices received academic detailing.
- Improvements in adolescent preventive service delivery were observed in both commercial and Medicaid populations.
- Significant increases were noted in tobacco use screening/counseling, substance use screening, and HIV counseling, especially within the Medicaid population (p <.05 for all Medicaid and HIV differences).
Conclusions:
- The initiative effectively improved adolescent preventive services for Medicaid beneficiaries in New York.
- Academic detailing is a valuable strategy for health plans to drive preventive care improvements among primary care clinicians.
- Further research is necessary to fully ascertain the impact on commercially insured adolescent populations.