Transcript Document 7209586

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 Children’s Healthcare Foundation
Confidential: For Quality Improvement Purposes Only
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 child’s 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
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
1.
2.
Achieve 75% compliance with “Developmental Screening” at
designated well child visits
Provide education to improve knowledge and skills of pediatric health
care providers
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3.
Use of formal developmental screening tools
Child development and behavior, family education, local community
resources
Increase appropriate and timely referrals to community resources
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Early intervention
School
Private therapy
Community agencies
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Solutions Implemented
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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
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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
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Site-Specific Implementation
Pilot sites: LOC Pediatrics & North Riverside
PLAN
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Meeting with site physicians
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Test Developmental Screenings with each physician
Meeting with site manager/clinical coordinator
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Share national statistics and AAP policy statement
Discuss screening tool options
Decide site-specific timing of screenings
Plan work-flow changes
Plan for staff education
Developed a site-specific toolkit and referral book
Staff education
DO
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Implementation
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On-site technical assistance with screenings and problem-solve workflow issues
STUDY
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Chart reviews to monitor screenings
ACT
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Follow-up meeting to discuss feedback and ways to improve screening process
Confidential: For Quality Improvement Purposes Only
Developmental Screening at Well-Child Visits
Overall Project Results July 07 - March 08
All sites have achieved the 75% target
100%
90%
Target: 75%
80%
Percent Compliance
70%
60%
50%
40%
30%
20%
10%
0%
LOC Peds
N River
Wheaton
Darien
Maywood FP
Glendale
Elmhurst/OP
Hickory
Oak Brook
Orland Pk
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Post-Screening Referral Rate
Overall Project Results July 07 - March 08
Overall referral rate post implementation is 10%
35%
30%
25%
20%
15%
10%
5%
0%
LOC Peds
N River
Wheaton
Darien
Maywood FP
Glendale
Elmhurst/OP
Hickory
Oak Brook
Orland Pk
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
Analysis
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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
Next Steps
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Continue site-specific chart reviews and technical
assistance
Expand Loyola’s 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