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Narrowing Care Gaps for Early Language Delay: A Quality Improvement Study
Courtney M Brown1, Andrew F Beck2, Wendy Steuerwald2
1Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA courtneym.brown@cchmc.org.
Insights
System changes improved access to speech and hearing services for low-income children, increasing appointment attendance from 40% to 60% and eliminating disparities.
Area of Science:
- Pediatrics
- Public Health
- Speech-Language Pathology
Background:
- Poverty is a significant risk factor for language delays in children.
- Limited access to timely therapies exacerbates developmental challenges for low-income families.
- Urban primary care settings often face challenges in connecting children to essential speech and audiology services.
Purpose of the Study:
- To improve access to early intervention services for children aged 0-3 years.
- To increase the rate of initial speech pathology or audiology appointments attended within 60 days.
- To raise referral adherence from 40% to a target of 60% for children from an urban primary care center.
Main Methods:
- Utilized the Model for Improvement framework to design and implement interventions.
- Addressed logistical barriers commonly faced by low-income families accessing healthcare.
- Employed run charts for time-series analysis of adherence and subgroup analysis to assess disparity reduction.
Main Results:
- Median referral adherence increased from 40% to 60% post-intervention.
- Pre-intervention disparities in adherence were observed, with lower rates in lower-income neighborhoods.
- These socioeconomic disparities in adherence were eliminated following the intervention.
Conclusions:
- System-level interventions effectively enhanced access to crucial evaluations and treatments for children with language delays.
- The study successfully narrowed the access gap for speech and audiology services between lower and higher-income families.
- Targeted improvements in care delivery can mitigate socioeconomic barriers to early intervention.
Background And Objective:
Poverty is a risk factor for both language delay and failure to access appropriate therapies. The objective of this study was to increase the percentage of children 0 to 3 years old referred from an urban primary care center who attended an initial appointment with speech pathology or audiology within 60 days from 40% to 60%.
Methods:
The Model for Improvement was used to develop and test the intervention, which addressed potential logistical barriers faced by low-income families. Adherence was plotted on run charts in time series to assess overall improvement, and subgroups were analyzed to identify reduction in disparities.
Results:
Median referral adherence improved from 40% to 60%. Families from lower income neighborhoods had lower preintervention adherence; these differences were eliminated postintervention.
Conclusions:
System-level changes improved access to evaluation and treatment for low-income children with language delay and narrowed the gap in access between families in lower versus higher income neighborhoods.
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