Institute for Health Policy and Practice (IHPP)

NH Pediatric Improvement Partnership

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UNH Scholars' Repository

• Learning collaborative did not meet the 80% target, though positive change was seen in each measure.• Measurement Challenges• Lag time between screen completion & “counting” it in performance metric• Sequential implementation of screens at WCV limits ability to see performance change for 9 mo. project • Referral data was hard to capture in some EHRs• Referral patterns proved difficult to impact as some providers opted to see patients back in clinic prior to referral.• Introducing screening did not lengthen visits.• Significant decrease in provider perception about difficulty of using ASQ • All clinics are still screening and have made changes to continue to improve/sustain their rates.• Standard operating procedures, staff training, billing, and enhanced systems to track children at risk• Continuing to track performance. One clinic added screening to its internal quality “dashboard” • Clinicians involved were invested in outcomes, but less invested in quality improvement principles/strategiesDevelopmental Screening Quality Improvement Initiative: A Learning Collaborative of the New Hampshire Pediatric Improvement PartnershipConclusions & DiscussionAcknowledgementsAimsEvaluation1) To increase the proportion of children <3 screened for developmental delay with a standardized screening tool (Ages and Stages Questionnaire (ASQ)) to 80% at 3 different time points (<1, <2, <3)2) To increase the proportion of children with failed developmental screen who have documented referral for additional services to 80%ResultsWe would like to acknowledge the work of Dr. Nina Sand-Loud, content expert, and Sue Butts-Dion, quality improvement coach, as well as the clinical site teams, Developmental Screening Advisory Committee members, the UNH Research Computing Center and NH Dept. of Health and Human Services.BackgroundFour participating practices:• An estimated 14% of US children have a developmental delay.• 20-30% of these children will not be diagnosed until after the start of kindergarten.• Identifying developmental delay early is crucial to early childhood development.• The American Academy of Pediatrics endorses developmental screening at the 9, 18, and 30 month well child checks.• Parent and provider surveys indicate that developmental screening practices in New Hampshire are suboptimal.• Chart review for baseline data• Monthly review of electronic health records to assess progress toward aims• Bimonthly clinic progress reports • Systems of care survey before and after collaborative• Assess changes in clinic systems/attitudes• Evaluations of training, tools, and technical assistance • Assess participant satisfaction with collaborativeSamantha House, DO, MPH; Molly O’Neil, BS; Josephine Porter, MPH; Alison Holmes, MD, MPH; Ardis Olson, MD; Holly Tutko, MSDesign• Dover Pediatrics• Dartmouth Hitchcock Keene• Monadnock Regional Pediatrics • Core Physicians Two Phases:• Pre-Work (3 months)• Review importance of developmental screening/quality improvement models• Explain project design/expectations• Meet with quality improvement coach• Implementation (9 months)• Monthly conferences calls and team meetings• Up to 5 coaching visits per practice• Two in-person learning sessions• One webinarAim: Increase to 80% the proportion of children who turned 1 year old in the past month who has a documented screening. Aim: Increase to 80% the proportion of children who turned 1, 2, or 3 years old in the past month who has a documented screening. Aim: Increase to 80% the proportion of children less than three years of age with a failed score on a standardized developmental screening instrument who have a documented clinician referral for additional services 0123456Bill for developmental screening Have a standing operating procedurefor screeningTeach office staff to conductdevelopmental surveillance orscreeningNumber of clinics responding yesPrePostPre and post-intervention survey dataBarrier Pre- Survey  MeanPost-survey MeanHow long and difficult the ASQ is to implement and score 4.3 2.3*Don’t have a standard operating procedure for screening implementation3.7 2.3 Cost to acquire the tool 3 1.8 Unclear about billing/reimbursement for screening 3.2 2 Lack of training on how to implement screening tool 3.8 2.7 Screening interrupts patient flow 3.8 2.8 Amount of time/labor needed to monitor referrals (e.g. appt. made, family went)2.7 1.7 *Statistically SignificantQuote from one Clinic Team Leader: “We’re finally meeting the standard of care for developmental screening in our practice and in a sustainable manner”.

Developmental Screening Quality Improvement Initiative: A Learning Collaborative of the New Hampshire Pediatric Improvement Partnership

https://scholars.unh.edu/cgi/viewcontent.cgi?article=1135&context=ihpp

Developmental Screening Quality Improvement Initiative: A Learning Collaborative of the New Hampshire Pediatric Improvement Partnership

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