Improving Pediatric Care Through Interoffice Screening

Saturday, October 26, 2019

12:00 PM – 1:00 PM

Location: Hilton New Orleans Riverside, Canal

Introduction: Screening and identification of developmental milestones, autism, and social determinants of health is a vital component in caring for pediatric patients within a medical home. As 1 in 4 children in the US have developmental delay and 1 in 5 children struggle with hunger, these issues are present in all clinics. Despite This high prevalence, only 40% of primary care providers screen for these. In cooperation with the American Academy of Pediatrics quality improvement collaborative Project I-SCRN (Improving Screening, Connections with families, and Referral Networks); a one year multi-site study was completed. The aim was improving documentation and identification for these topics through interoffice screening.
METHODOLOGY: Screening implementation included the Ages and stages questionnaires (ASQ), Modified Checklist for Autism in Toddlers (M-CHAT), Edinburgh Postnatal Depression Screening (EPDS), and hunger vital sign. Screenings were distributed by front office staff at pre-set well checks to achieve consistency across all offices. Chart review was completed for each cycle at 9, 18, and 30 month well child visits. Parent surveys were completed at the beginning, middle, and end of the study. PDSA cycles were utilized throughout the study to identify: visits to screen, implementation schedule, and screenings to use. Implementation of ASQ and M-CHAT was completed by Cycle 2. EPDS was initiated in Cycle 5. Hunger Vital Sign was implemented in Cycle 9. Asset mapping for the geographically diverse catchment area was completed to identify resources for families with positive screenings.

Results: Each screening showed significant increase in documentation throughout the study. ASQ increased from an average of 69% to 83%. M-CHAT increased from an average of 73% to 93%. EPDS increased from 0% to 83% over 9 months. Hunger vital sign increased from 0% to 60% over 5 months. Parent surveys from beginning to the end of the study showed satisfaction ratings increase by 15% across all practices. Monthly practice meetings helped to improve documentation rates. The asset mapping proved to be invaluable throughout the study to provide resources for positive screenings. Tracking and following referrals for positive screenings remained challenging throughout the study. This deficiency was attributed to poor tracking capabilities of the electronic medical record and insufficient staff.

Discussion: Through this study documentation and identification of developmental delays, autism, and social determinants of health was improved with the use of interoffice screenings. The study established that screenings helped improve patient satisfaction and this in turn improved provider participation. Post study chart review has shown reduction in screening documentation. Further meetings with providers are needed to ensure sustainability of these interventions. Future work is needed in relation to more unified physician participation, expansion outside of pediatrics, ease of access to screening, and tracking of referrals.

Speaker(s)

Emily Conant, MD

Professor & Chief, Division of Breast Imaging
Perelman School of Medicine at the University of Pennsylvania
Perelman School of Medicine, University of Pennsylvania

Disclosure: Disclosure information not submitted.