క్లినికల్ పీడియాట్రిక్స్: ఓపెన్ యాక్సెస్
అందరికి ప్రవేశం
ISSN: 2572-0775
ISSN: 2572-0775
Zana Khoury and Alexandra Epee-Bounya
Background: Consistent and timely delivery of comprehensive preventative care services is a challenge, particularly in underserved patient populations. Previous quality improvement research has focused on the development of bundled measures of preventative services delivery, but these bundles have not been studied on a population level. We aimed to improve preventative care service delivery on a clinic population level through the use of a bundled measure that includes immunizations, lead screening, and use of screening tools among underserved patients under 2 years old.
Methods: A quality improvement study was conducted at a community-based academic primary care clinic. A population-level bundled measure was adapted from an existing tool. We used Plan, Do, Study, Act (PDSA) cycles to optimize results and tracked bundle outcome rates using a p-type Statistical Process Control chart. Interventions included 1) staff education on measure components, 2) introduction of exam room-based phlebotomy to address lead screening completion rates, and 3) population management strategies, including development of a patient registry and use of reminders and visit tracking to increase attendance at well-child visits.
Results: The percent of bundle completion by 14 months of age increased from a baseline of 58% to 77% following implementation of the quality improvement initiatives. A mean shift was identified after the population manager began proactive targeted outreach for the 12 month visit.
Conclusion: Targeted systems for outreach aimed at bringing patients into the clinic and patient-centered strategies for visit completion are effective at ensuring timely delivery of comprehensive preventative care to an underserved pediatric population.