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Going Paperless: Using Electronic Questionnaires to Improve the Quality of Well-Child Checkups
Brian T Ketterman1, Kathryn L Carlson2, Merrill Stoppelbein2
1Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt.
Insights
Implementing electronic questionnaires significantly improved well-child checkups (WCCs), increasing completion rates from 45.6% to 84.7%. This quality improvement initiative also boosted referrals to community resources, though language disparities persist.
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.
Objective:
At our large, university-affiliated primary care clinic, we aimed to enhance the quality of well-child checkups (WCCs) to align with Bright Futures/American Academy of Pediatrics recommendations. Our primary goal was to increase the rate of complete WCCs from 45.6% to 80% by April 2024. Our secondary aims were to ensure WCC improvement for all language groups and to increase referrals to 2 community partners.
Methods:
A multidisciplinary team initiated a quality improvement project primarily focused on transitioning from paper-based to electronic questionnaires for patient screenings. Clinic processes were developed to assist families in completing questionnaires. The percentage of complete WCCs was the primary outcome measure. We defined complete WCCs as those that included note documentation of all required patient-reported elements. Our primary outcome measure was analyzed by using statistical process control charts to identify special cause variation.
Results:
We reviewed 51 809 WCCs from July 2022 to April 2024, and the rate of complete WCCs improved from 45.6% to 84.7%. We significantly improved the rates for all measured aspects of WCCs as follows: 7 different common pediatric questionnaires and 7 routine WCC assessments. Referrals to 2 community nutrition and literacy resources increased. Despite large improvements across all language groups, disparities remained for patients who spoke languages other than English.
Conclusions:
Transitioning to electronic questionnaires and revised clinic procedures led to more comprehensive WCCs and connected more families with community resources. Although progress was made across all language groups, we note ongoing challenges in eliminating disparities.
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