Implementing developmental screening and referrals: lessons learned from a national project.

Area of Science:

• Pediatric healthcare implementation science
• Child development screening and surveillance
• Healthcare quality improvement

Background:

• The American Academy of Pediatrics (AAP) issued developmental screening guidelines in 2006.
• A pilot project involved 17 pediatric practices implementing these AAP recommendations.

Purpose of the Study:

• To evaluate the implementation of AAP developmental screening and referral guidelines in pediatric practices.
• To identify factors influencing the success and challenges of implementation.

Main Methods:

• Quantitative chart reviews assessed screening and referral rates.
• Qualitative semistructured interviews explored implementation efforts and challenges.

Main Results:

• Practices screened over 85% of eligible children using parent-completed instruments, often prioritizing clinic flow.
• Significant difficulties were encountered in adhering to specific AAP recommendations, particularly regarding referrals (61% of failed screens referred).
• Referral tracking and patient follow-through posed substantial challenges for many practices.

Conclusions:

• Pediatric practices demonstrated success in implementing developmental screening protocols.
• The referral process and tracking referrals present significant implementation gaps.
• Separate systems for screening and referral processes may be necessary for optimal outcomes.