Screenings during Well-Child Visits in Primary Care: A Quality Improvement Study

Area of Science:

• Pediatrics
• Public Health
• Health Services Research

Background:

• Early Periodic Screening, Diagnosis, and Treatment (EPSTD) visits are crucial for monitoring the health of children enrolled in Medicaid.
• These visits aim to address physical, mental, and developmental health comprehensively.

Purpose of the Study:

• To assess the impact of a quality improvement intervention on screening rates and identify barriers within EPSTD visits at an academic family medicine clinic.
• To improve the delivery and outcomes of essential child health screenings.

Main Methods:

• A mixed-methods approach combining quantitative (pre/post intervention screening rates) and qualitative (interviews) analyses was employed.
• Interventions included educational materials, checklists, and standardized order sets, informed by initial barrier assessments.

Main Results:

• Significant improvements were observed in ordered rates for anemia and lead tests, and in screening/referral rates for oral health.
• Vision and hearing test ordering and confirmation rates also showed statistically significant improvement (P < .05).
• Qualitative data revealed persistent barriers: venipuncture challenges, medical assistant reluctance for vision screening, and ill-fitting hearing equipment.

Conclusions:

• Office-based quality improvement processes can effectively enhance EPSTD screenings for children.
• Addressing identified barriers through targeted strategies, such as fingerstick testing and improved equipment, is essential for continued quality improvement.