Substance Use Screening in a Large Pediatric Primary Care Network: A Quality Improvement Project.

Area of Science:

• Adolescent Health
• Public Health
• Quality Improvement Science

Background:

• Substance use screening is crucial for adolescent health.
• The CRAFFT (Car, Relax, Alone, Forget, Family/Friends, Trouble) tool is designed for adolescent substance use screening.
• Integrating screening tools into routine care presents implementation challenges.

Purpose of the Study:

• To implement and evaluate the integration of the CRAFFT screening tool into routine adolescent primary care.
• To expand a successful single-site implementation to a large, multi-site primary care network.
• To assess the reliability and effectiveness of quality improvement strategies in facilitating widespread adoption of the CRAFFT screener.

Main Methods:

• Quality improvement methodologies were employed to facilitate the adoption and use of the CRAFFT screener across 34 primary care sites.
• Data on screening rates for eligible adolescents were collected and shared monthly with providers.
• The project expanded from a single site to a 34-site children's hospital primary care network.

Main Results:

• The single-site phase demonstrated a substantial increase in screening rates from 3.5% to 72%.
• The network phase rapidly achieved and sustained screening rates exceeding 90% within two months.
• During the network phase, 93% (35,750 of 38,427) of eligible patients completed the CRAFFT screening.

Conclusions:

• The project successfully established highly reliable use of the CRAFFT screener within a large primary care network.
• Quality improvement strategies were effective in driving widespread adoption of adolescent substance use screening.
• Routine screening using the CRAFFT tool is feasible and achievable in a large pediatric primary care setting.