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Implementation of Instrument-Based Vision Screening for Preschool-Age Children in Primary Care
Jonathan R Modest1, Katherine M Majzoub2, Bruce Moore3
1Pediatric Physicians' Organization at Children's, Brookline, Massachusetts.
Insights
Instrument-based vision screening significantly improved detection rates in young children during well-child visits. This method also increased family satisfaction and reduced unnecessary referrals to eye care specialists.
Area of Science:
- Pediatric primary care
- Public health
- Ophthalmology
Background:
- Vision screening is crucial for early detection in pediatric well-child care.
- Instrument-based screening is recommended but lacks effectiveness data in primary care.
Purpose of the Study:
- To evaluate the implementation and effectiveness of instrument-based vision screening in pediatric primary care.
- To assess impacts on screening completion rates, family satisfaction, and specialist referrals.
Main Methods:
- A cluster randomized quality improvement project was conducted across 12 pediatric practices.
- Instrument-based vision screening was implemented for children aged 3–5 years.
- Outcomes included screening completion, family satisfaction, and referral rates.
Main Results:
- Completed vision screening increased from 54% to 89% (Phase 1) and 65% to 92% (Phase 2).
- Screening rates for 3-year-olds improved from 39% to 87% with instrument screening.
- Family satisfaction was higher, and referrals decreased by 15%.
Conclusions:
- Instrument-based vision screening is effectively implementable in pediatric primary care.
- It substantially improves screening rates and may reduce unnecessary specialist referrals.
- Further research is needed on overcoming implementation barriers and long-term effects.
Background:
Vision screening is an essential element of well-child care for young children. Recently, several professional groups have recommended the use of instrument-based screening; however, studies demonstrating the effectiveness of this technique in pediatric primary care settings are lacking.
Methods:
We designed a cluster randomized quality improvement project to test the implementation of instrument-based vision screening for 3- to 5-year-old children within a pediatric primary care network. The program consisted of 12 pediatric practices randomized into phase 1 and phase 2 groups. We evaluated the effect of the intervention on completed vision screening at well-child visits, family satisfaction, and referrals to eye care specialists.
Results:
Instrument-based vision screening increased completed screening among 3- to 5-year-old children from 54% to 89% in the phase 1 group and from 65% to 92% in the phase 2 group. Improvement was most marked among 3-year-old children, with completed screening increasing from 39% with chart-based screening to 87% with instrument screening. Family satisfaction was higher with instrument screening. In addition, instrument screening was associated with a 15% reduction in referrals to eye care specialists.
Conclusions:
Instrument-based vision screening for preschool-aged children can be effectively implemented into primary care practice, results in substantially improved rates of completed vision screening at well-child visits, and may result in a reduction in unnecessary referrals to eye care specialists. Additional research is needed regarding how best to overcome barriers to the widespread use of this technology in pediatric primary care settings, as well as its longer-term effect on referrals and the prevalence of amblyopia.
