Improving Adolescent Preventive Care in an Urban Pediatric Clinic: Capturing Missed Opportunities

To increase the proportion of adolescents with Medicaid who receive preventive care services in an urban pediatric clinic.

A quality improvement intervention was implemented at an urban pediatric primary care clinic between November 2013 and October 2014. The intervention systematically "flipped" acute visits into well-care visits for patients ages 12-21 years, when overdue. The primary process measure was the percentage of acute visits expanded to include well-care components out of total eligible opportunities. The primary outcome measure was adolescent well-care (AWC) completion in 2014 versus 2013 and 2012.

Among 857 adolescents with Medicaid, 124 additional AWC visits were completed by October 2014 compared to 2013 and 71 additional visits compared to 2012. The gap to achieving Healthcare Effectiveness Data and Information Set neutral zone targets for AWC was reduced by 59% compared to 2013 and by 54% compared to 2012. The mean proportion of eligible acute opportunities "flipped" monthly increased from 17% (range: 10%-21%) during the initial 3 months of implementation to 30% (range: 5%-50%) in the last 3 months.

Systematically flipping acute visits into well visits resulted in reaching Healthcare Effectiveness Data and Information Set quality targets for AWC, which had not previously been accomplished by this clinic. Incorporating staff and provider feedback strengthened intervention fidelity and buy-in despite time constraints in a busy, urban setting.