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Increasing Recommended Care for Immigrant Children in an Ambulatory Care Network
Zachary S Berlant1,2, Mariellen M Lane2, Laura E Robbins-Milne2
1From the Department of Pediatrics, NewYork-Presbyterian Morgan Stanley Children's Hospital , New York, N.Y.
Insights
A quality improvement project successfully increased recommended pediatric care for migrant children, more than doubling compliance rates. This initiative utilized electronic health record aids and provider input to meet the unique needs of this vulnerable population.
Area of Science:
- Pediatric primary care
- Public health
- Quality improvement science
Background:
- The American Academy of Pediatrics has guidelines for immigrant child healthcare.
- A needs assessment indicated that these recommendations were not consistently met in pediatric primary care settings.
- There is a gap in providing recommended care for migrant children.
Purpose of the Study:
- To implement a quality improvement project to increase the delivery of recommended care for migrant children.
- To assess the impact of electronic health record aids, education, and provider input on care provision.
- To improve adherence to American Academy of Pediatrics recommendations for migrant children's health.
Main Methods:
- A 1-year quality improvement project was conducted from October 2021.
- Interventions included electronic health record aids, education, and provider input.
- Provider compliance was tracked using statistical process control charts, comparing pre- and post-intervention rates.
Main Results:
- Monthly compliance rates increased significantly, from a baseline of 24.4% to 56.1%.
- The quality improvement interventions demonstrated a special cause variation, indicating a significant impact.
- Rates of delivering recommended care for migrant children more than doubled from baseline.
Conclusions:
- Quality improvement methodology effectively increased the provision of recommended care for migrant children.
- The project successfully exceeded its goal for care provision rates.
- The interventions led to a sustained increase in the delivery of essential pediatric care for this population.
Introduction:
The American Academy of Pediatrics has established recommendations to ensure that the unique needs of immigrant children are addressed in pediatric primary care. A needs assessment of a single institution's pediatric ambulatory network revealed that the majority of recommendations were not provided.
Methods:
A 1-year quality improvement (QI) project starting in October 2021 used electronic health record aids, education, and provider input to increase the rate of providing recommended care for migrant children 18 years of age or younger in a general pediatrics ambulatory network. The primary outcome was whether providers delivered the majority of the 5 universally recommended aspects of care established by the American Academy of Pediatrics for migrant children. The secondary outcomes included each of the 5 recommended care elements evaluated individually. The process measure was the use of electronic health record aids. Rates of provider compliance with providing a majority of recommended care were tracked with a statistical process control chart and compared with those of 20 months prior.
Results:
Monthly compliance rates increased from a baseline mean of 24.4% to 56.1%. Following the first QI intervention, a run of 11 consecutive points above the centerline met the statistical process control rules for special cause variation.
Conclusions:
Using QI methodology, rates of delivering recommended care for all migrant children exceeded the goal and more than doubled from baseline. The shift initiated at the start of the QI project, and the maximal rate of care provision peaked at the end of the QI period.
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