Improving Delivery of Bright Futures Preventive Services at the 9- and 24-Month Well Child Visit

Abstract

OBJECTIVES: To determine if clinicians and staff from 21 diverse primary care practice settings could implement the 2008 Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd edition recommendations, at the 9-and 24-month preventive services visits.METHODS: Twenty-two practice settings from 15 states were selected from 51 applicants to participate in the Preventive Services Improvement Project (PreSIP). Practices participated in a 9-month modified Breakthrough Series Collaborative from January to November 2011. Outcome measures reflect whether the 17 components of Bright Futures recommendations were performed at the 9-and 24-month visits for at least 85% of visits. Additional measures identified which office systems were in place before and after the collaborative.RESULTS: There was a statistically significant increase for all 17 measures. Overall participating practices achieved an 85% completion rate for the preventive services measures except for discussion of parental strengths, which was reported in 70% of the charts. The preventive services score, a summary score for all the chart audit measures, increased significantly for both the 9-month (7 measures) and 24-month visits (8 measures).CONCLUSIONS: Clinicians and staff from various practice settings were able to implement the majority of the Bright Futures recommended preventive services at the 9-and 24-month visits at a high level after participation in a 9-month modified Breakthrough Series collaborative.

A Parent Coach Model for Well-Child Care Among Low-Income Children: A Randomized Controlled Trial

“…The inclusion of nonphysicians as part of a team approach to care is widely recognized as a key component in preventive care quality improvement and WCC delivery system redesign. 13,[36][37][38] In a recent review of tools and strategies to improve WCC, we found evidence suggesting that inclusion of nonphysician providers into a health care team could improve receipt of anticipatory guidance and developmental and behavioral services. 16,17,[39][40][41][42] In Healthy Steps, a physician and child developmental specialist (typically a nurse, social worker, or early childhood educator) provide WCC in partnership.…”

Explanation and elaboration of the SQUIRE (Standards for Quality Improvement Reporting Excellence) Guidelines, V.2.0: examples of SQUIRE elements in the healthcare improvement literature

“…Practices were selected to represent diversity in practice types, practice settings, and patient populations. In each selected practice the lead core team physician and in some cases the whole practice had previous QI experience…table 1 summarizes practice characteristics for the 21 project teams 28…”

“…Similar information is also provided in aggregate for multicentre studies. In the second example by Duncan et al ,28 a table is used to describe the practice characteristics of the 21 participating paediatric primary care practices, and includes information on practice type, practice setting, practice size, patient characteristics and use of an electronic health record. This information can be used by the reader to assess whether his or her own practice setting is similar enough to the practices included in this report to enable extrapolation of the results.…”

Maintenance of Certification and the Challenge of Professionalism

“…A separate methods paper from the same authors described the use of MOC as an incentive for participation in I-PASS. 32 Duncan et al 28 showed that a QI collaborative increased the use of "Bright Futures" preventive services during child well-visits. This collaborative functioned under the auspices of the American Academy of Pediatrics Quality Improvement Innovation Networks, for which MOC credit is awarded.…”