Established Evidence Results

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Participation Incentives, Quality Improvement/Practice-Wide Intervention, Expert Support (Provider), Modified Billing Practices, Data Collection Training for Staff, Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Engagement with Payers, STATE, POPULATION-BASED SYSTEMS, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: The Vermont Child Health Improvement Program (VCHIP) at the University of Vermont collaborated with state agencies and professional societies to conduct a survey of Vermont pediatric and family medicine practices regarding their developmental screening and autism screening processes, referral patterns, and barriers. The survey was administered in 2009 to 103 primary care practices, with a 65% response rate (89% for pediatric practices, 53% for family medicine practices).

Intervention Results: The survey results revealed that while 88% of practices have a specific approach to developmental surveillance and 87% perform developmental screening, only 1 in 4 use structured tools with good psychometric properties. Autism screening was performed by 59% of practices, with most using the M-CHAT or CHAT tool and screening most commonly at the 18-month visit. When concerns were identified, 72% referred to a developmental pediatrician and over 50% to early intervention. Key barriers to both developmental and autism screening were lack of time, staff, and training. Over 80% of practices used a note in the patient chart to track at-risk children, and most commonly referred to child development clinics, audiology, early intervention, and pediatric specialists.

Conclusion: The survey conducted by VCHIP revealed wide variation in developmental and autism screening practices among Vermont pediatric and family medicine practices. While most practices conduct some form of screening, there is room for improvement in the use of validated tools, adherence to recommended screening ages, and implementation of office systems for tracking at-risk children. The survey identified knowledge gaps and barriers that can be addressed through quality improvement initiatives, which most respondents expressed interest in participating in.

Study Design: QE: pretest-posttest

Setting: Pediatric and family medicine practices in Vermont

Population of Focus: Children up to age 3

Data Source: Child medical record; ProPHDS Survey

Sample Size: Chart audits at 37 baseline and 35 follow-up sites (n=30 per site) Baseline charts (n=1381) - Children 19-23 months (n=697) - Children 31-35 months (n=684) Follow-up charts (n=1301) - Children 19-23 months (n=646) - Children 31-35 months (n=655)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Participation Incentives, Modified Billing Practices, Data Collection Training for Staff, Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Engagement with Payers, STATE, POPULATION-BASED SYSTEMS, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: Early identification of children with developmental and behavioral delays is important in primary care practice, and well-child visits provide an ideal opportunity to engage parents and perform periodic screening. Integration of this activity into office process and flow is necessary for making screening a routine and consistent part of primary care practice.

Intervention Results: In the North Carolina Assuring Better Child Health and Development Project, careful attention to and training for office process has resulted in a significant increase in screening rates to >70% of the designated well-child visits. The data from the project prompted a change in Medicaid policy, and screening is now statewide in primary practices that perform Early Periodic Screening, Diagnosis, and Treatment examinations.

Conclusion: Although there are features of the project that are unique to North Carolina, there are also elements that are transferable to any practice or state interested in integrating child development services into the medical home.

Study Design: QE: pretest-posttest

Setting: Partnership for Health Management, a network within Community Care of North Carolina

Population of Focus: Children ages 6 to 60 months receiving Early Periodic Screening, Diagnosis, and Treatment services

Data Source: Child medical record

Sample Size: Unknown number of charts – screening rates tracked in 2 counties (>20,000 screens by 2004)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Expert Support (Provider), Modified Billing Practices, Screening Tool Implementation Training, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, Engagement with Payers, STATE, POPULATION-BASED SYSTEMS, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: This report evaluates the impact of Phase II of Maine's First STEPS initiative

Intervention Results: Average percentage of documented use of a developmental screening tool increased substantially from baseline to followup for all three age groups (46% to 97% for children under one; 22% to 71% for children 18-23 months; and 22% to 58% for children 24-35 months). Rate of developmental screening based on MaineCare claims increased from the year prior to intervention implementation to the year after implementation for all three age groups (5.3% to 17.1% for children age one; 1.5% to 13.3% for children age two; and 1.2% to 3.3% for children age 3).

Conclusion: The authors summarize lessons learned in implementing changes in practices and challenges in using CHIPRA and IHOC developmental, autism, and lead screening measures at the practice-level to inform quality improvement.

Study Design: QE: pretest-posttest

Setting: Pediatric and family practices serving children with MaineCoverage

Population of Focus: Children ages 6 to 35 months

Data Source: Child medical record; MaineCare paid claims

Sample Size: Unknown number of chart reviews from 9 practice sites completing follow-up

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool, POPULATION-BASED SYSTEMS, STATE, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: The objectives of this study were to assess the feasibility of implementing a bundle of strategies to facilitate the use of Bright Futures recommendations and to evaluate the effectiveness of a modified learning collaborative in improving preventive and developmental care.

Intervention Results: Office system changes most frequently adopted were use of recall/reminder systems (87%), a checklist to link to community resources (80%), and systematic identification of children with special health care needs (80%). From baseline to follow-up, increases were observed in the use of recall/reminder systems, the proportion of children's charts that had a preventive services prompting system, and the families who were asked about special health care needs. Of 21 possible office system components, the median number used increased from 10 to 15. Comparing scores between baseline and follow-up for each practice site, the change was significant. Teams reported that the implementation of office systems was facilitated by the perception that a component could be applied quickly and/or easily. Barriers to implementation included costs, the time required, and lack of agreement with the recommendations.

Conclusion: This project demonstrated the feasibility of implementing specific strategies for improving preventive and developmental care for young children in a wide variety of practices. It also confirmed the usefulness of a modified learning collaborative in achieving these results. This model may be useful for disseminating office system improvements to other settings that provide care for young children.

Study Design: QE: pretest-posttest

Setting: Primary care practices (15 at baseline, 8 at follow- up) throughout the US (9 states total), with most in the Midwest

Population of Focus: Children from birth through 21 years of age

Data Source: Child medical record

Sample Size: Unknown number of chart audits from 8 practice sites completing follow-up

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): PROVIDER/PRACTICE, Provider Training/Education, Educational Material (Provider), Expert Support (Provider), Participation Incentives, Quality Improvement/Practice-Wide Intervention, Data Collection Training for Staff, Expert Feedback Using the Plan-Do-Study-Act-Tool, Collaboration with Local Agencies (State), Collaboration with Local Agencies (Health Care Provider/Practice), STATE, POPULATION-BASED SYSTEMS, Audit/Attestation, HEALTH_CARE_PROVIDER_PRACTICE, Audit/Attestation (Provider)

Intervention Description: Seven pediatric primary care practices participated in New Mexico's Developmental Screening Initiative in a year-long quality improvement project with the goal of implementing standardized developmental screening tools.

Intervention Results: At baseline, there were dramatic differences among the practices, with some not engaged in screening at all.

Conclusion: Overall, the use of standardized developmental screening increased from 27% at baseline to 92% at the end of the project.

Study Design: QE: pretest-posttest

Setting: Seven primary care practices in a large urban area and small regional community in New Mexico

Population of Focus: Children ages 1 through 60 months

Data Source: Child medical record

Sample Size: Total medical records reviewed at baseline and follow-up (n=1139)

Age Range: Not specified

Intervention Components (click on component to see a list of all articles that use that intervention): Communication Tools, Office Systems Assessments and Implementation Training, Expert Feedback Using the Plan-Do-Study-Act-Tool,

Intervention Description: The intervention description in the study "Increasing Warm Handoffs: Optimizing Community Based Referrals in Primary Care Using QI Methodology" included several key components aimed at improving the warm handoff process and referral workflow. Some of the interventions implemented during the study period are as follows: 1. Dedicating CHW Space: The study involved dedicating space near providers for Community Health Workers (CHWs) and creating electronic CHW schedules and warm handoff blocks. 2. Improving Communication: Efforts were made to improve communication with providers using email and huddle reminders, as well as posting informative signs in exam rooms to facilitate the warm handoff process. 3. Workflow Enhancements: Workflow enhancements were implemented, including the creation of warm handoff blocks in the electronic medical record (EMR) and the CHW's schedule, as well as the co-location of CHWs with pediatricians for a specified period each week. 4. Regular Updates and Reminders: Monthly update emails were sent to the entire clinic staff, providing program data, workflow reminders, and success stories of patients who were referred to community resources. Additionally, workflow reminders were placed in exam rooms to prompt and enable providers to conduct warm handoffs. 5. Leadership Engagement: Leadership buy-in to the workflow changes was emphasized, and monthly emails were used to keep providers and staff updated on the screening and referral workflow and improvement initiatives. Success stories of patients who connected with a referral resource were shared to positively reinforce referral behavior. These interventions were part of the Plan-Do-Study-Act (PDSA) cycles performed during the study and were aimed at optimizing the warm handoff process and increasing the effectiveness of referrals for patients with unmet social needs.

Intervention Results: Using quality improvement (QI) methods our pediatric clinic worked to increase the warm handoff rate between Community Health Workers (CHWs) and patients with unmet social needs. CHW warm handoff rates increased two-fold over the intervention period. Our results illustrate that QI methods can be used to optimize workflows to increase warm handoffs with CHWs.

Conclusion: Yes, the study reported statistically significant findings related to the impact of the interventions on increasing warm handoffs with Community Health Workers (CHWs) and improving the referral process for patients with unmet social needs. Specifically, the study found the following statistically significant results: 1. CHW Referral Rate: The study reported a significantly higher referral rate in the intervention period compared to the baseline period (P = 0.03). 2. Warm Handoff Rate: The study found a statistically significant increase in the warm handoff rate between families requesting assistance with unmet social needs and CHWs over the intervention period compared to the baseline period (P < 0.001). These statistically significant findings indicate that the quality improvement (QI) interventions implemented during the study had a significant impact on increasing the warm handoff rate and improving the referral process for patients with unmet social needs.

Study Design: The study design used in the research article is a quality improvement (QI) project. The study aimed to optimize community-based referrals in primary care using QI methodology. The authors used Plan-Do-Study-Act (PDSA) cycles to test and implement interventions aimed at increasing the warm handoff rate between patients with unmet social needs requesting assistance and Community Health Workers (CHWs). The study used a pre-post design, comparing the baseline period to the intervention period, to evaluate the effectiveness of the interventions. The study did not use a randomized controlled trial (RCT) design, which is commonly used in clinical research to evaluate the effectiveness of interventions.

Setting: The setting for the study was a pediatric clinic affiliated with the Albert Einstein College of Medicine and Montefiore Medical Group in Bronx, NY, USA. The study took place at an academic-affiliated Federally Qualified Health Center (FQHC) where providers and residents are accustomed to partaking in Quality Improvement (QI) and research projects. The clinic served underserved communities and aimed to optimize community-based referrals in primary care using QI methodology.

Population of Focus: The target audience for the study includes healthcare professionals, particularly those working in pediatric primary care settings, as well as professionals involved in community health and social services. Additionally, individuals and organizations involved in quality improvement initiatives within healthcare settings may also find the study relevant. The findings and recommendations of the study are likely to be of interest to practitioners, researchers, and policymakers seeking to improve social needs screening and referral programs, especially in underserved communities.

Sample Size: The sample size for the study was not explicitly mentioned in the provided excerpts. However, the study reported that a total of 3100 patients were screened for social needs in the baseline period, and 6278 patients were screened in the intervention period. Additionally, the study mentioned that 527 patients (8.4%) were referred to a Community Health Worker (CHW) in the intervention period. While the specific sample size for the intervention group was not provided, the study's findings were based on the outcomes observed during the intervention period involving the referred patients.

Age Range: The provided excerpts from the study "Increasing Warm Handoffs: Optimizing Community Based Referrals in Primary Care Using QI Methodology" did not explicitly mention the specific age range of the study participants. However, based on the context of the study, which focused on pediatric care and addressing the social needs of families, it can be inferred that the study likely involved children and their families. The study primarily focused on the impact of warm handoffs and referrals in a pediatric clinic, indicating that the age range of the study participants likely encompassed children and possibly their caregivers or family members.

Intervention Components (click on component to see a list of all articles that use that intervention): Screening Tool Implementation, Quality Improvement, Expert Feedback Using the Plan-Do-Study-Act-Tool, Screening in Nontraditional Settings

Intervention Description: The intervention includes a standardized postpartum depression screening tool into pediatric primary care practice to increase postpartum depression screening rates.

Intervention Results: The study found that postpartum depression screening practices improved from 83% to 88% after the implementation of the standardized screening tool, although this improvement was not statistically significant . The study also found that certain infant and family characteristics, such as male gender, Medicaid or sliding-scale payment for services, and Hispanic ethnicity, were associated with higher rates of positive postpartum depression screens, although again, these associations were not statistically significant . Another study mentioned in the text found that the implementation of a standardized screening tool increased the rate of screening for postpartum depression from 83% to 100%

Conclusion: Pediatric health care providers can effectively screen for postpartum depression. Certain infant and family characteristics may alert the provider to higher risks for mothers.

Study Design: The study design/type is not explicitly mentioned in the given texts. However, the study is a quality improvement project that aimed to improve postpartum depression screening in a pediatric primary care clinic . The study used pre- and post-intervention data to compare the screening rates before and after the implementation of a standardized screening tool . Therefore, it can be classified as a quasi-experimental study.

Setting: The quality improvement project took place in a nurse-led, rural FQHC (Federally Qualified Health Center) in north-central Indiana that offers primary care services, including pediatrics, family health, women's health, and behavioral health

Population of Focus: The target audience for this study is pediatric health care providers who are interested in improving postpartum depression screening in their practice

Sample Size: The sample size for this study was 116 women

Age Range: The age group is not specified in the given texts. However, since the study is about postpartum depression screening, it can be inferred that the sample consists of women who have recently given birth

Intervention Components (click on component to see a list of all articles that use that intervention): Expert Feedback Using the Plan-Do-Study-Act-Tool, Clinical Decision Support System,

Intervention Description: This study aimed to determine whether youth access behavioral health (BH) care earlier (i.e., when problems are less severe) when receiving services in colocated pediatric primary care clinics. Six primary care clinics in the Midwest with a colocated BH provider participated in this study. Data on number of sessions attended/not attended with the BH provider, BH symptom severity as measured by the Child Behavior Checklist, parent report of length of presenting problem, and improvement ratings were collected and compared for on-site referrals and off-site referrals. Descriptive, independent sample t tests and regression analyses compared those referred from on-site physicians versus off-site referral sources.

Intervention Results: Results demonstrated that youth receiving BH services at their primary care physician's office accessed services when problems were less severe and had been impacting their functioning for a shorter duration.

Conclusion: This study is among the first to explore whether youth receiving BH services in primary care are accessing those services earlier than those who are referred from outside sources, resulting in improved patient outcomes.

Study Design: Medical record reviews

Setting: Six colocated primary care clinics in the Midwest region of the United States

Population of Focus: Pediatric patients who initiated behavioral health treatment in six colocated primary care clinics in the Midwest

Sample Size: 617 children

Age Range: Children ages 1 to 19 years old