Screenings during Well-Child Visits in Primary Care: A Quality Improvement Study

Abstract

Background: Early Periodic Screening, Diagnosis, and Treatment visits are designed to address physical, mental, and developmental health of children enrolled in Medicaid.Methods: We conducted a mixed methods intervention by using a quality improvement theory. We assessed preintervention and postintervention screening rates of development, anemia, lead, oral health, vision and hearing, interventions for improvement, and barriers for the well-child visits at an academic family medicine clinic. For quantitative analysis, we assessed the preintervention baseline for 183 children and postintervention outcome for 151 children. For qualitative analysis, we used group interviews and key informant interviews to develop interventions in the preintervention stage and to explore potential barriers for further improvement in the postintervention stage.Results: Interventions based on baseline results included user-friendly materials, checklists, posters, education, and order sets. After the intervention, there were significant statistical improvements (P < .05) for the anemia test ordered rate, serum lead test ordered rate, oral health screening and referral rates, and ordered and confirmed test rates for both vision and hearing. Despite these improvements, 3 qualitative findings indicated barriers for further improvement, including difficulties in venipuncture, medical assistant aversion to vision screening, and poor fit of equipment for hearing assessment. The procedures prompted further continuous quality improvement activities using fingerstick hemoglobin testing, a child-friendly vision screener, and manual audiometer with headphones.Conclusions: The trial findings demonstrated potential benefits of improving screenings in an officebased intervention by using a quality improvement process. Postintervention qualitative findings illustrate additional factors that could be addressed for further improvements. (J Am Board Fam Med 2018; 31:558 -569.)

Reducing health disparities: Adherence to referrals for further diagnosis among asylum seeking children

“…Nurses are highly valued and trusted by the public (Rubin et al., 2017). This emphasizes the need to increase good and open communication with the parents to convince them to adhere to recommendations contained in referrals (Chung et al., 2006), market the importance of screening tests and their value for the future life of the child (Wakai et al., 2018) and, most importantly, recognize families with difficulties and help them deal with their challenges (Perry et al., 2017).…”

Blood Lead Testing Among Medically Underserved and Socially Vulnerable Children in the United States 2012-2017

“…Findings could support HCs in improving blood lead testing by screening those who required a blood lead test (eg, Medicaid covered patients) and educating parents/guardians about lead exposure at early wellchild visit in primary care settings. 22 Previous research has identified barriers to childhood lead screening, such as cost, lack of insurance, and absence of symptoms. 23 In addition, inadequate parental adherence to physician-ordered screening and physician noncompliance with screening recommendations are barriers to childhood lead screening.…”

Continuous quality improvement methodology: a case study on multidisciplinary collaboration to improve chlamydia screening

“…The scale of the QI project can vary from a single clinical site to a large multispecialty group as the above example used. For example, Wakai et al 25 conducted a QI project in a single site but included an intervention. Focused on improvement of periodic assessments, they identified and addressed barriers and threats to the project’s success.…”