Background and Aims The American Academy of Pediatrics recommends that all children, as part of well child care, have validated developmental screening in the medical home. Testing increases the early identification of children with developmental delay and improves outcome. However, USA data show that many primary care practices do not provide this screening. Our goal was to understand these barriers in our own practice, to overcome them, and to achieve 100% developmental screening rates.
Methods Our QI workgroup used electronic surveys and focus group discussion to solicit parent expectations, to understand provider barriers, and to explore work flow issues. Using this information to drive PDSA cycles and LEAN initiatives in our practice, we instituted educational training, workflow adjustments, screening tool modification, computerized tracking, and the redesign of select well child visits to focus on development screening.
Results The use of a validated screening tool by non-pediatric providers in our practice was 0% at the initiation of intervention. The major barriers to screening were lack of provider time, lack of comfort in developmental/behavioral pediatrics, lack of familiarity with a screening tool, and perceived lack of need for formalized testing. Following implementation of changes, including the modification of specific well visits to focus on developmental screening, 100% of eligible children had validated developmental screening performed over the last two months.
Conclusion Educational intervention, work flow modification, and the refocus of select well visits can significantly improve developmental screening rates in practice.