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Updated: Jun 3, 2025
Measuring the Functional Abilities of Children Aged 3-6 Years Old with Observational Methods and Computer Tools
Published on: June 20, 2020
Improving Access to Early Developmental Evaluation in Academic Primary Care Centers
Zeina M Samaan1, Pamela Williams-Arya2, Kristen Copeland1
1From the Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OHIO.
Insights
Early intervention for developmental disorders (DDs) is crucial. A new scheduling process doubled the rate of children aged 3-5 completing developmental evaluations within 90 days, improving access to care.
Area of Science:
- Pediatrics
- Developmental Psychology
- Health Services Research
Background:
- Developmental disorders (DDs) affect 1 in 6 US children, with early identification and treatment significantly improving outcomes.
- Disparities in DD diagnosis lead to inequitable access to crucial developmental services during critical neuroplasticity periods.
- Improving access to developmental evaluations for preschool-aged children (3-5 years) is essential for timely diagnosis and intervention.
Purpose of the Study:
- To enhance access to developmental and behavioral pediatrics (DBP) clinics for children aged 3-5 experiencing developmental delays.
- To increase the percentage of children who schedule and complete an initial DBP visit within 90 days from 20% to 40%.
Main Methods:
- Utilized the Institute of Health Improvement model, including failure modes and effects analysis, a key driver diagram, and plan-do-study-act cycles.
- Implemented an expedited, collaborative referral and scheduling process between general pediatric clinics and DBP stakeholders.
- Incorporated additional interventions such as reminder notifications and calls for missed appointments.
Main Results:
- The percentage of referred patients who scheduled and completed their initial DBP visit within 90 days increased from 20% to 40%.
- DBP clinicians identified children with global developmental delay and/or autism spectrum disorder for further specialized testing.
- The quality improvement initiative successfully improved access to developmental evaluations.
Conclusions:
- Quality improvement methodologies, focusing on flexible scheduling within the medical home, can effectively improve access to developmental evaluations.
- This approach addresses disparities and ensures timely diagnosis and treatment for preschool-aged children at risk for developmental delays.
- Enhanced access to DBP services facilitates better developmental outcomes for young children and their families.
Introduction:
Developmental disorders (DDs) affect approximately 1 in 6 children in the United States. Early identification and treatment improve developmental outcomes and child and family functioning. Disparities exist in the diagnosis of DD that leads to inequitable access to developmental services during important periods of neuroplasticity. Improve access to the developmental and behavioral pediatrics (DBP) clinic for developmental evaluation when developmental delays occur among children 3-5 years of age by increasing the percentage of children scheduled for and completing an initial visit in 90 days from 20% to 40%.
Methods:
We used the Institute of Health Improvement model, executed mapping failure modes, created a key driver diagram and conducted plan-do-study-act cycles. We plotted data over time in a statistical control chart. The key intervention was an expedited, collaborative referral and scheduling process developed, tested, and implemented by the general pediatric clinic and DBP stakeholders. Additional interventions included reminder notifications and calls to patients who missed appointments.
Results:
The percentage of patients referred to DBP who scheduled and completed their initial visit in DBP within 90 days increased from 20% to 40%. DBP clinicians suspecting that patients had global developmental delay and/or autism spectrum disorder at the initial DBP visit referred them for more extensive developmental testing with psychology and speech-language providers.
Conclusions:
Access to developmental evaluation for preschool-aged children at risk for delayed diagnosis and treatment was improved using quality improvement methodology focused on flexible and creative priority scheduling practices from within the medical home.
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