Title: Big Strides for Small Patients: Developmental Screening in Pediatric Primary Care
1Big 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
2The 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
3Aim 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
4Solutions 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
5Site-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
6Target 75
Confidential For Quality Improvement Purposes
Only
7The 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
8Analysis
- 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
9Next 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