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Increasing Early Childhood Screening in Primary Care Through a Quality Improvement Collaborative.

Kori B Flower1,2, Sara Massie2, Kathryn Janies3

  • 1Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; kflower@unc.edu.

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Summary

Pediatric practices improved early childhood screenings for development, autism, maternal depression, and social determinants of health. This quality improvement project enhanced screening, discussion, referral, and follow-up processes.

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Area of Science:

  • Pediatric Primary Care
  • Quality Improvement Science
  • Early Childhood Development

Background:

  • Early childhood screenings are crucial but often underimplemented.
  • Gaps exist in screening, discussion, referral, and follow-up for key developmental and health areas.
  • Improving these processes is vital for early intervention and better child outcomes.

Purpose of the Study:

  • To enhance the screening, discussion, referral, and follow-up of development, autism spectrum disorder (ASD), maternal depression, and social determinants of health (SDoH).
  • To achieve a 90% implementation rate for these screenings and subsequent actions by July 2018.
  • To assess the impact of a quality improvement collaborative on pediatric primary care practices.

Main Methods:

  • A 1-year national quality improvement collaborative involving 19 pediatric primary care practices.
  • Implementation of changes to early childhood screening processes supported by learning opportunities.
  • Monthly chart reviews and parent surveys to assess screening, discussion, referral, and follow-up rates.

Main Results:

  • Development and ASD screening goals exceeded 90%.
  • Significant increases in maternal depression screening (27% to 87%) and SDoH screening (26% to 76%).
  • Statistically significant improvements in discussion and referral rates across all screening areas, with parent-reported increases as well.

Conclusions:

  • Pediatric practices can successfully implement multiple early childhood screenings.
  • Quality improvement initiatives can enhance screening, discussion, referral, and follow-up processes.
  • Continued advocacy for resources is necessary to ensure improved health outcomes from increased screening.