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

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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.

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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.