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Results of a primary care-based quality improvement project to optimize chart-based vision screening for preschool
Jonathan R Modest1, Suzanne C Johnston2, Katherine M Majzoub3
1Pediatric Physicians' Organization at Children's, Brookline, Massachusetts.
Insights
Implementing chart-based vision screening for preschoolers proved challenging, with success rates varying by age. While improving for 4- and 5-year-olds, it declined for 3-year-olds, highlighting age-related difficulties in pediatric vision screening.
Area of Science:
- Ophthalmology
- Pediatrics
- Public Health
Background:
- Early detection of vision impairments in preschool children is crucial for development.
- Chart-based vision screening is a common method, but its effectiveness in young children needs evaluation.
- Quality improvement initiatives aim to enhance screening completion rates.
Purpose of the Study:
- To design and evaluate a chart-based vision screening program for preschool-aged children.
- To assess the feasibility and success of implementing vision screening at well-child visits.
- To identify factors influencing the completion of comprehensive vision screening.
Main Methods:
- A quality improvement project involving educational sessions for providers and training for practice staff.
- Pre- and post-intervention review of medical records to assess screening completion.
- Analysis of screening data for children aged 3, 4, and 5 years.
Main Results:
- Full vision screening completion improved for 5-year-olds (45.0% to 58.2%) and 4-year-olds (39.3% to 51.4%).
- Screening completion declined for 3-year-olds (23.1% to 14.3%).
- Being 3 years old (RR 4.1) and attending a small practice (RR 1.9) were risk factors for incomplete screening.
Conclusions:
- Chart-based vision screening for visual acuity and stereovision in preschool children is challenging.
- Consistent success in screening preschool-aged children, particularly 3-year-olds, is unlikely with current chart-based methods.
- Further improvements or alternative methods may be needed for effective pediatric vision screening.
Purpose:
To design chart-based vision screening for preschool-aged children.
Methods:
Our program consisted of educational sessions for providers as well as hands-on training for practice staff. We evaluated the intervention through pre- and post-intervention review of medical records.
Results:
Completion of full vision screening (distance visual acuity in each eye plus stereovision beginning at 3 years of age, as recommended at the time of the project) at well-child visits improved for 5-year-olds (45.0% to 58.2%; risk difference +13.2% [95% CI, 1.7-24.7]) and 4-year-olds (39.3% to 51.4%; risk difference +12.0% [95% CI, 0.7-23.4]) but declined somewhat among 3-year-olds (23.1% to 14.3%; risk difference, -8.8% [95% CI, -17.7 to 0.0]). Risk factors for not being fully screened included being 3 years old (risk ratio of 4.1 compared to 5-year-olds) and being a patient of a small practice (risk ratio of 1.9 compared to large practices).
Conclusions:
This quality improvement project showed that screening for visual acuity and stereovision among preschool-aged children using chart-based techniques is difficult to accomplish and unlikely to be consistently successful, especially among 3-year-olds.
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