Practice-tailored facilitation to improve pediatric preventive care delivery: a randomized trial

Area of Science:

• Primary Care Research
• Quality Improvement in Pediatrics
• Health Services Research

Background:

• Evolving primary care models necessitate effective strategies to meet quality standards.
• Pediatric preventive services are crucial for child health and development.
• Existing methods may not adequately support practices in delivering these services consistently.

Purpose of the Study:

• To assess the effectiveness of a Practice-Tailored Facilitation Intervention.
• To improve the delivery of three key pediatric preventive services: obesity screening/counseling, lead screening, and dental fluoride varnish application.

Main Methods:

• A cluster-randomized trial involving 30 practices.
• Implementation of practice-tailored rapid-cycle feedback and change strategies by a practice facilitator.
• Outcomes assessed across 16,419 well-child visits using comparative case study methods for facilitation processes.

Main Results:

• Significant improvements observed in all three preventive services within 4 months of intervention initiation.
• Obesity screening performance increased from baseline (3.5-6.3%) to over 80% in early intervention practices.
• Lead screening and fluoride varnish application also showed substantial increases, with sustained improvements noted 2 months post-intervention.

Conclusions:

• The Practice-Tailored Facilitation Intervention demonstrates a powerful capacity to drive significant, simultaneous, and sustained improvements in pediatric preventive care.
• This approach holds considerable promise as a scalable method for advancing the quality of pediatric preventive services across diverse practice settings.
• Key elements for successful facilitation include multidisciplinary support, rapid feedback loops, and adaptive relationship-building tailored to practice needs.