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Improving Infant Continuity of Care in an Academic Center Clinic: A Quality Improvement Project
Abiye Y Okah1, Morgen L Govindan1, Rachael D Dameron1
1From the Department of Pediatrics, Division of General Academic Pediatrics, Children's Mercy Kansas City, 2410 Gillham Road, Kansas City, MO 64108..
Insights
Continuity of care (COC) for infants improved significantly through a quality improvement project. The percentage of infants seeing the same provider for at least three well-child visits increased from 9% to 60% and was sustained.
Area of Science:
- Pediatrics
- Healthcare Quality Improvement
- Primary Care Medicine
Background:
- Continuity of care (COC) is crucial for patient-centered medical homes.
- Provider activities in academic settings and pandemic disruptions can negatively impact infant COC.
- A decrease in infant COC was observed at an academic primary care clinic.
Purpose of the Study:
- To implement a quality improvement (QI) project aimed at enhancing infant COC.
- To increase the percentage of infants who establish consistent care with an identified provider during their first year.
Main Methods:
- A QI project was conducted from 2021 to 2023, focusing on root causes like access and scheduling.
- Interventions included scheduling well visits at hospital discharge and establishing a preferred medical home provider.
- Process measures tracked future well checks and medical home establishment.
Main Results:
- Infant COC, defined as seeing the same provider for at least 3 of 6 well-child checks, increased from a baseline of 9% to 60%.
- This improvement was achieved by June 2023 and sustained through December 2023.
- The QI project successfully addressed barriers to consistent infant care.
Conclusions:
- The implemented outpatient QI project effectively improved infant COC with sustained positive outcomes.
- Future research will assess the long-term impact of these interventions on continuity of care.
- This study highlights the success of targeted QI initiatives in pediatric primary care.
Introduction:
Continuity of care (COC) with an identified provider is a key principle of the patient-centered medical home. COC may be impacted by other activities that providers practicing in an academic center must engage in. The disruption of care processes during the COVID-19 pandemic led to a decrease in COC for infants attending our academic center's primary care clinic. We implemented a quality improvement (QI) project to improve the rates of infant COC.
Methods:
In 2021, we implemented a QI project with the aim of increasing the percentage of 12-month-old infants who had seen the same provider for at least 3 of the recommended 6 well-child checks in infancy. QI methodology was used to determine root causes of the problem, which included access, scheduling, and the patient-provider relationship. Process measures included tracking scheduled future well checks for newborns and 4-month-old infants, as well as establishing a medical home provider. Multiple Plan-Do-Study-Act cycles were implemented, including scheduling well visits at newborn hospital discharge, scheduling by clinic nurses, and establishing the family's preferred medical home provider.
Results:
The percentage of infants seeing the same provider for at least 3 well visits in the first year of life increased from a baseline of 9% in July 2021 to 60% in June 2023. This was sustained through December 2023.
Conclusions:
An outpatient QI project to improve infant COC was successfully implemented with sustained outcomes. Next steps include evaluating the effect of these interventions on future continuity.
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