Impact of healthy steps on developmental referral rates

Diagnosis and treatment of pediatric mental, physical, and behavioral issues are essential for optimal growth and development. Our family medicine residency program implemented a change in our pediatric curriculum by incorporating aspects of Healthy Steps into well-child visits 1 day a week. This study was done to determine the impact on developmental referral rates after incorporating Healthy Steps.

We did a retrospective medical records review at a rural California family medicine residency clinic on children through 5 years of age receiving well-child care. We collected developmental referrals as documented in the chart and in a referral log for 1 year before the curriculum change and 3 years after implementation. This retrospective case-control study included a pre-intervention group (Pre) and two post-intervention groups, usual care control (UC) and Healthy Steps intervention (HS). The three groups were compared using Fisher's exact tests.

Developmental referrals assessed by chart review were 0% (0/154) in Pre, 0.6% (1/159) in UC, and 5.4% (4/74) in HS groups. When assessed by referral logs, developmental referral rates were 1.2% (10/864) in Pre, 1.1% (14/1,251) in UC, and 9.9% (14/141) in HS groups. For both sources, the HS group had significantly higher referral rates than the other groups. There was no statistical difference in referrals between the Pre and UC groups.

After incorporating aspects of Healthy Steps into our curriculum, developmental referrals rose significantly in the intervention group compared to pre-intervention. Referral rates did not change in the non-intervention control group.