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Implementation of a Preventive Services Bundle in Academic Pediatric Primary Care Centers
Zeina Marcho Samaan1, Courtney M Brown2, John Morehous2
1Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio zeina.samaan@cchmc.org.
Insights
This study improved preventive service delivery for young children in primary care. The redesigned approach increased the percentage of eligible patients receiving a bundle of essential services from 58% to 92%.
Area of Science:
- Pediatric Primary Care
- Quality Improvement Science
- Preventive Health Services
Background:
- Delivery of preventive services in primary care settings is often suboptimal.
- This study addresses the need to improve the reliability of comprehensive preventive care for infants and young children.
Purpose of the Study:
- To increase the reliable delivery of a bundle of key preventive services for patients aged 0 to 14 months.
- The target was to improve service delivery from 58% to 95% of eligible patient visits.
Main Methods:
- A quality improvement methodology was employed across three academic pediatric primary care clinics serving a predominantly Medicaid population.
- Key interventions included developing an "Ideal Visit Flow," utilizing a Responsible, Accountable, Support, Consulted, and Informed (RASCI) matrix, and implementing Plan-Do-Study-Act (PDSA) cycles.
- Performance was tracked weekly using run charts and statistical process control methods.
Main Results:
- The pre-intervention rate of patients aged 0 to 14 months receiving all eligible preventive service bundle elements was 58%.
- Following the intervention, the post-intervention rate increased significantly to 92%.
Conclusions:
- An innovative redesign of care processes successfully improved the delivery of a comprehensive preventive services bundle for young children.
- Critical success factors included multidisciplinary teams, optimized visit workflows, clear communication, and dedicated data and project management resources.
Background And Objectives:
Previous studies have documented poor rates of delivery of preventive services, 1 of the core services provided in the primary care medical home setting. We aimed to increase the reliability of delivering a bundle of preventive services to patients 0 to 14 months of age from 58% of patient visits to 95% of visits. The bundle includes administration of routine vaccinations, offering influenza vaccination, completed lead screening, completed developmental screening tool, screening for maternal depression and food insecurity, and documentation of gestational age.
Methods:
The setting was 3 academic pediatric primary care clinics that serve 31,000 patients (>90% Medicaid). Quality improvement methodology was used and key driver diagram was determined. Patient "Ideal Visit Flow" and the Responsible, Accountable, Support, Consulted, and Informed Matrix were developed to drive accountability for components of the ideal flow. Plan, Do, Study, Act cycles were used to develop successful interventions. The percent of patients seen who received all bundle elements for which they were eligible was plotted weekly on a run chart, and statistical process control methods were used to determine a significant change in performance.
Results:
The preintervention percentage of patient visits ages 0 to 14 months receiving all preventive service bundle elements was 58%. The postintervention percentage is 92%.
Conclusions:
Innovative redesign led to improvement in percentage of patients age 0 to 14 months who received the entire preventive services bundle. Key elements for success were multidisciplinary site-specific teams, redesigned visit flow, effective communication, and resources for data and project management.
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