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"First Five" Quality Improvement Program Increases Adherence and Continuity with Well-child Care
Maya Bunik1,2,3, Kelly Galloway3, Mike Maughlin3
1Department of Pediatrics, University of Colorado Anschutz Medical Campus.
Insights
This quality improvement project successfully increased adherence to essential "First Five" well-child visits and enhanced provider continuity. The interventions led to significant improvements in pediatric preventive care access and consistency for young children.
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.
Abstract:
The American Academy of Pediatrics Bright Futures recommends routine well-child care as optimal care for children. This quality improvement project aimed to increase adherence to the "First Five" visits after newborn follow-up at 2, 4, 6, 9, and 12 months-by 25% (50% or higher) and continuity with providers by 20% (64% or higher) between 2013 and 2016.
Methods:
Retrospective data collection identified a quality gap, in which only 25% had the required well-child visits by the first year. We interviewed parents/caregivers of 12- to 15-month-old children for their perspectives on access to care, scheduling, and the medical home concept. Plan-Do-Study-Act cycles targeted modification of electronic medical record templates, scheduling, staff and parental education, standardization of work processes, and birth to 1-year age-specific incentives. We then piloted interventions in one of our clinic's pod/subgroup. Process and outcome measures were analyzed using descriptive statistics, a run chart, and a 2-sample % Defective Test.
Results:
Parent/caregiver interviews revealed that only 6% knew what a medical home was, and only 40% "almost always saw the same provider for care." At baseline in 2012, we documented completion of all 5 visits in only 25% of the children; <10% of those children had consecutive visits with the same provider. After multiple Plan-Do-Study-Act cycles and pilot, our "First Five" well-child care adherence rose to 78%, and continuity increased to 74% in 2018 (P < 0.001 for adherence, P < 0.001 for continuity).
Conclusion:
A multifaceted, evidence-based approach improved both well-child care adherence and provider continuity.
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