Development of a bundle measure for preventive service delivery to infants in primary care

Area of Science:

• Pediatric primary care
• Preventive health services
• Healthcare quality improvement

Background:

• Paediatric patients in the US receive only 41% of indicated preventive services.
• Previous improvement efforts have not bundled preventive services to assess comprehensive infant care.
• There is a need for a reliable measure of overall preventive service status in infants.

Purpose of the Study:

• To create a comprehensive bundle measure for assessing the reliable delivery of preventive services in primary care.
• To evaluate the overall preventive service status of infants within three primary care centers.
• To establish a baseline for future quality improvement initiatives in pediatric preventive care.

Main Methods:

• Utilized electronic health records for infants under 14 months old across three primary care centers.
• Developed a preventive services bundle including immunizations, lead screening, developmental screening, and biopsychosocial risk factor screening.
• Constructed monthly and visit-level bundle measures to assess service delivery and completion rates.

Main Results:

• Only 22% of infants (n=278) born in May 2011 received the complete preventive services bundle by 14 months of age.
• At the visit level, all indicated services were delivered only 58% of the time.
• Established baseline performance data for infants born in May 2011 and visit-level performance from July to August 2012.

Conclusions:

• A novel bundle measure effectively characterizes preventive service delivery in paediatric primary care.
• The bundle measure can be utilized to drive quality improvement at both individual visit and population levels.
• Findings underscore significant gaps in the delivery of comprehensive preventive care for infants.