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Interventions to improve screening and follow-up in primary care: a systematic review of the evidence
Jeanne Van Cleave1, Karen A Kuhlthau, Sheila Bloom
1Center for Child & Adolescent Health Research and Policy, MassGeneral Hospital for Children, Boston, MA 02114, USA. jvancleave@partners.org
Insights
Practice-based interventions can improve pediatric screening rates. However, evidence for improving follow-up care after screening is limited, requiring further research.
Area of Science:
- Pediatric Primary Care
- Preventive Health Services
- Health Services Research
Background:
- Preventive care guidelines recommend numerous screening tests for children.
- Current screening and follow-up care rates in pediatric primary care are suboptimal.
Purpose of the Study:
- To systematically review evidence on practice-based interventions aimed at enhancing screening and follow-up services in pediatric primary care.
- To identify effective strategies for improving the delivery of recommended health screenings for children and young adults.
Main Methods:
- A systematic literature search of the MEDLINE database was conducted.
- Studies included primary care-based interventions in children and young adults (≤21 years) with post-intervention screening data.
- Data were abstracted from 23 selected articles, with a focus on intervention types and reported outcomes.
Main Results:
- Twelve of 14 studies with preintervention or control data showed increased screening proportions.
- Effective interventions included provider/staff training, electronic medical record enhancements, and learning collaboratives.
- Few studies addressed tracking screening results or referral completion for abnormal tests.
Conclusions:
- Practice- and provider-level interventions show promise for improving pediatric screening quality.
- There is a notable lack of evidence regarding interventions that improve the follow-up of screening tests.
- Future research should investigate intervention sustainability, comparative effectiveness, and strategies for enhancing follow-up care.
Background:
The American Academy of Pediatrics and other organizations recommend several screening tests as part of preventive care. The proportion of children who are appropriately screened and who receive follow-up care is low.
Objective:
To conduct a systematic review of the evidence for practice-based interventions to increase the proportion of patients receiving recommended screening and follow-up services in pediatric primary care.
Data Source:
Medline database of journal citations.
Study Eligibility Criteria, Participants, And Interventions:
We developed a strategy to search MEDLINE to identify relevant articles. We selected search terms to capture categories of conditions (eg, developmental disabilities, obesity), screening tests, specific interventions (eg, quality improvement initiatives, electronic records enhancements), and primary care. We searched references of selected articles and reviewed articles suggested by experts. We included all studies with a distinct, primary care-based intervention and post-intervention screening data, and studies that focused on children and young adults (≤21 years of age). We excluded studies of newborn screening.
Study Appraisal And Synthesis Methods:
Abstracts were screened by 2 reviewers and articles with relevant abstracts received full text review and were evaluated for inclusion criteria. A structured tool was used to abstract data from selected articles. Because of heterogeneous interventions and outcomes, we did not attempt a meta-analysis.
Results:
From 2547 returned titles and abstracts, 23 articles were reviewed. Nine were pre-post comparisons, 5 were randomized trials, 3 were postintervention comparisons with a control group, 3 were postintervention cross-sectional analyses only, and 3 reported time series data. Of 14 articles with preintervention or control group data and significance testing, 12 reported increases in the proportion of patients appropriately screened. Interventions were heterogeneous and often multifaceted, and several types of interventions, such as provider/staff training, electronic medical record templates/prompts, and learning collaboratives, appeared effective in improving screening quality. Few articles described interventions to track screening results or referral completion for those with abnormal tests. Data were often limited by single-site, nonrandomized design.
Conclusions:
Several feasible, practice- and provider-level interventions appear to increase the quality of screening in pediatric primary care. Evidence for interventions to improve follow-up of screening tests is scant. Future research should focus on which specific interventions are most effective, whether effects are sustained over time, and what interventions improve follow-up of abnormal screening tests.
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