"First Five" Quality Improvement Program Increases Adherence and Continuity with Well-child Care

Area of Science:

• Pediatric Healthcare Quality Improvement
• Preventive Health Services Research
• Health Services Management

Background:

• Routine well-child care is recommended by the American Academy of Pediatrics Bright Futures for optimal child health.
• A significant quality gap existed, with only 25% of children completing the recommended "First Five" well-child visits by age one.
• Low provider continuity was observed, with only 40% of parents consistently seeing the same provider.

Purpose of the Study:

• To increase adherence to the "First Five" well-child visits (2, 4, 6, 9, 12 months) by 25% (to ≥50%).
• To improve continuity with healthcare providers by 20% (to ≥64%) between 2013 and 2016.
• To identify parental perspectives on access, scheduling, and the medical home concept.

Main Methods:

• Retrospective data analysis identified baseline quality gaps in well-child visit adherence and provider continuity.
• Parent/caregiver interviews gathered insights into barriers and facilitators of care access and continuity.
• Plan-Do-Study-Act (PDSA) cycles informed interventions, including EMR template modifications, scheduling adjustments, staff/parent education, process standardization, and age-specific incentives.
• Interventions were piloted in a clinic subgroup, with process and outcome measures analyzed using descriptive statistics and run charts.

Main Results:

• Baseline data showed only 25% adherence to "First Five" visits and <10% provider continuity.
• Parent interviews revealed low awareness of the "medical home" concept (6%) and moderate provider continuity (40%).
• Following PDSA cycles and pilot interventions, well-child care adherence increased to 78% and provider continuity to 74% (P < 0.001 for both).

Conclusions:

• A multifaceted, evidence-based quality improvement strategy effectively enhanced well-child care adherence.
• The project successfully improved provider continuity in pediatric primary care.
• Targeted interventions can significantly overcome barriers to preventive pediatric care access and consistency.