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Big Strides for Small Patients: Developmental Screening in Pediatric Primary Care

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Big Strides for Small Patients: Developmental Screening in Pediatric Primary Care Department of Pediatrics Jerold Stirling, MD Rebecca Turk, MD – PowerPoint PPT presentation

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Title: Big Strides for Small Patients: Developmental Screening in Pediatric Primary Care


1
Big Strides for Small Patients Developmental
Screening in Pediatric Primary Care
  • Department of Pediatrics
  • Jerold Stirling, MD
  • Rebecca Turk, MD
  • Melanie Arvanitakis, MS
  • April Gann, MS
  • Holly Nandan, MHA/MBA, CHE
  • Made possible by a grant from the Illinois
    Childrens Healthcare Foundation

Confidential For Quality Improvement Purposes
Only
2
The Opportunity
  • It is estimated that 16 percent of children have
    developmental and/or behavioral disorders
    however, only 30 of these disorders are
    identified before the child starts school. Many
    physicians use Developmental Surveillance, an
    informal developmental checklist, to monitor a
    childs development.
  • The American Academy of Pediatrics (AAP) issued a
    policy statement in 2006, which recommended
    formal Developmental Screening, use of a formal
    standardized screening tool, to monitor
    development at 9, 18 and 24 month well-child
    visits. (1)
  • Prior to this project, a self-reported survey of
    Loyola physicians indicated that 4.5 of these
    physicians used formal standardized
    Developmental Screening tools for well-child
    visits.

(1) Policy Statement-Identifying Infants and
Young Children with Developmental Disorders in
the Medical Home An Algorithm for Developmental
Surveillance and Screening. Pediatrics, July
2006, 118-1, 405-420.
Confidential For Quality Improvement Purposes
Only
3
Aim Statement
  • Develop and implement an integrated, sustainable
    developmental screening program for the children,
    ages 0-5, receiving primary pediatric care across
    Loyola University Health System
  • Achieve 75 compliance with Developmental
    Screening at designated well child visits
  • Provide education to improve knowledge and skills
    of pediatric health care providers
  • Use of formal developmental screening tools
  • Child development and behavior, family education,
    local community resources
  • Increase appropriate and timely referrals to
    community resources
  • Early intervention
  • School
  • Private therapy
  • Community agencies

Confidential For Quality Improvement Purposes
Only
4
Solutions Implemented
  • Secured grant funding and hired 1.5 FTE Child
    Development Specialists
  • Established a project Advisory Committee
  • Surveyed physicians to determine existing
    developmental screening practices across LUHS
  • Researched options for Developmental Screening
    tools
  • Built developmental screening resource webpage
    added to the Dept of Pediatrics site
  • Developed Epic prompts documentation
  • Developmental screening prompt in note
  • Documentation of screening results
  • Referral letter
  • Created implementation schedule for 11 sites
  • Built relationships with community organizations
    to create referral resource list

Confidential For Quality Improvement Purposes
Only
5
Site-Specific ImplementationPilot sites LOC
Pediatrics North Riverside
  • PLAN
  • Meeting with site physicians
  • Share national statistics and AAP policy
    statement
  • Discuss screening tool options
  • Decide site-specific timing of screenings
  • Test Developmental Screenings with each physician
  • Meeting with site manager/clinical coordinator
  • Plan work-flow changes
  • Plan for staff education
  • Developed a site-specific toolkit and referral
    book
  • Staff education
  • DO
  • Implementation
  • On-site technical assistance with screenings and
    problem-solve workflow issues
  • STUDY
  • Chart reviews to monitor screenings
  • ACT
  • Follow-up meeting to discuss feedback and ways to
    improve screening process

Confidential For Quality Improvement Purposes
Only
6
Target 75
Confidential For Quality Improvement Purposes
Only
7
The post screening referral rate represents the
percentage of patients who were identified as
having developmental concerns. All patients who
were identified as having developmental concerns
were given referrals for further evaluation.
Confidential For Quality Improvement Purposes
Only
8
Analysis
  • Project work exceeded targets
  • 89 overall rate for developmental screening
  • 46 (100) attending physicians were trained
  • 10 overall rate for referrals
  • Appropriate training and tools enabled
    developmentally appropriate care to become
    standard in a short amount of time
  • Development of site-specific workflows and
    referral networks was successful in reducing
    barriers and resistance to implementation
  • System changes in Epic standardized processes and
    improved compliance
  • Added developmental screening component to
    Pediatric Residency education

Confidential For Quality Improvement Purposes
Only
9
Next Steps
  • Continue site-specific chart reviews and
    technical assistance
  • Expand Loyolas community referral network to
    meet the developmental needs of all of our
    pediatric patients
  • Seek additional grant funding to implement
    expanded screening for autism, social-emotional
    development, maternal depression, and domestic
    violence/risk assessment
  • Explore opportunities to publish results as a
    role model to implement AAP recommendations for
    screening

Confidential For Quality Improvement Purposes
Only
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