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Navigating the path to equitable rheumatologic care for underserved children with quality improvement
Sheetal S Vora1,2,3, Sarah C Mabus3, Talia L Buitrago-Mogollon3,4
1Division of Rheumatology, Department of Pediatrics, Atrium Health Levine Children's Hospital, Charlotte, NC, United States.
Insights
This quality improvement project enhanced early detection of pediatric rheumatologic conditions in underserved populations. Prompt identification and referral processes increased patient referrals, ensuring timely access to specialized care.
Area of Science:
- Pediatric Rheumatology
- Quality Improvement Science
- Health Equity
Background:
- Underserved pediatric populations often face delayed or missed diagnoses of rheumatologic conditions.
- Safety-net primary care clinics serve families without private insurance, highlighting a need for improved access to specialist care.
- Early identification and intervention are crucial for managing pediatric rheumatologic diseases and preventing long-term complications.
Purpose of the Study:
- To implement a quality improvement project aimed at identifying children with rheumatologic conditions in underserved pediatric populations.
- To prevent delayed or missed diagnoses by optimizing the identification and referral processes within safety-net primary care clinics.
- To ensure prompt and accurate diagnosis and subsequent treatment of rheumatologic symptoms.
Main Methods:
- Collaboration with providers at a safety-net clinic to refine identification and subspecialty referral processes.
- Utilized the Model for Improvement framework with rapid Plan-Do-Study-Act (PDSA) cycles.
- Employed run and statistical process control charts for evaluating improvement in referral rates.
Main Results:
- Increased patient referrals for potential rheumatologic disease from zero in the prior 5 years to 15 within 1 year of project initiation.
- The rheumatology clinic successfully managed an increased referral volume, seeing all priority patients within 20 business days.
- Demonstrated a significant improvement in the identification and referral of pediatric patients with rheumatologic concerns.
Conclusions:
- Enhanced provider awareness of rheumatologic symptoms in safety-net settings is key.
- The use of visual aids and decision support tools facilitates efficient and accurate patient recognition and referral.
- Improved processes ensure timely access to pediatric rheumatology subspecialty care for vulnerable populations.
Objective:
The aim of this quality improvement project is to identify children with rheumatologic conditions to prevent delayed or missed diagnosis in underserved pediatric populations. Our focus is on prompt and accurate identification and subsequent treatment of rheumatologic symptoms in pediatric patients referred from Atrium Health safety-net primary care clinics that deliver care to families without private insurance, including those lacking insurance entirely.
Methods:
We collaborated with providers at one safety-net clinic to improve the processes of identification and subspecialty referral, resulting in an increase in the number of identified pediatric patients and referrals for these patients with potential rheumatologic disease. We used the Model for Improvement framework with rapid Plan-Do-Study-Act cycles and evaluated improvement with run and statistical process control charts.
Results:
We achieved improvement, with zero referrals in the previous 5 years for the targeted population increasing to 15 patient referrals within 1 year of project initiation. Despite this increase in referrals, the rheumatology clinic was able to see all priority patients within 20 business days from referral.
Conclusion:
An awareness of concerning rheumatologic symptoms in safety-net primary care clinics, combined with the use of both visual and decision aids, allows care teams to efficiently recognize and accurately refer patients needing specialty care.
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