Going Paperless: Using Electronic Questionnaires to Improve the Quality of Well-Child Checkups.

Area of Science:

• Primary Care Pediatrics
• Quality Improvement Science
• Health Informatics

Background:

• Well-child checkups (WCCs) are crucial for monitoring child development and adhering to established guidelines like Bright Futures/American Academy of Pediatrics.
• Current WCC completion rates at our large, university-affiliated clinic were suboptimal at 45.6%, necessitating a quality improvement initiative.
• Ensuring equitable WCC quality across diverse linguistic populations and increasing community resource referrals were secondary objectives.

Purpose of the Study:

• To enhance the quality of well-child checkups (WCCs) by increasing the rate of complete WCCs to 80% by April 2024.
• To improve WCC outcomes for all language groups served by the clinic.
• To increase referrals to community nutrition and literacy partners.

Main Methods:

• A multidisciplinary team led a quality improvement project focused on transitioning from paper-based to electronic screening questionnaires.
• New clinic processes were developed to support families in completing the electronic questionnaires.
• Statistical process control charts were used to analyze the primary outcome measure: the percentage of complete WCCs, defined by documented patient-reported elements.

Main Results:

• Review of 51,809 WCCs from July 2022 to April 2024 showed an improvement in complete WCCs from 45.6% to 84.7%.
• Significant improvements were observed across all measured aspects of WCCs, including 7 common pediatric questionnaires and 7 routine assessments.
• Referrals to community nutrition and literacy resources increased, but disparities in WCC completion rates persisted for non-English speaking patients.

Conclusions:

• The shift to electronic questionnaires and revised clinic procedures successfully enhanced WCC comprehensiveness and community resource linkage.
• While quality improved across all language groups, ongoing disparities highlight the need for continued targeted interventions.
• The project demonstrates the effectiveness of health informatics in improving primary care quality and patient outcomes.