National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Pediatrics. 2012 Sep;130(3):e669-75. doi: 10.1542/peds.2011-2920. Epub 2012 Aug 6.
To implement a 6-month quality improvement project in 15 primary care pediatric practices to improve short-term newborn screening (NBS) follow-up.
At the start of the project, each practice completed a survey to evaluate office systems related to NBS and completed a chart audit. Practice teams were provided information about NBS and trained in quality-improvement methods, and then implemented changes to improve care. Monthly chart audits over a 6-month period were completed to assess change.
At baseline, almost half of practices completed assessment of infants for NBS; after 6 months, 80% of practices completed assessment of all infants. Only 2 practices documented all in-range results and shared them with parents at baseline; by completion, 10 of 15 practices documented and shared in-range results for ≥ 70% of infants. Use of the American College of Medical Genetics ACTion sheets, a decision support tool, increased from 1 of 15 practices at baseline to 7 of 15 at completion.
Practices were successful in improving NBS processes, including assessment, documentation, and communication with families. Providers perceived no increase in provider time at first visit, 2- to 4-week visit, or during first contact with the family of an infant with an out-of-range result after implementation of improved processes. Primary care practices increased their use of decision support tools after the project.
在 15 家初级保健儿科诊所实施为期 6 个月的质量改进项目，以改善新生儿短期筛查（NBS）的后续工作。
在项目开始时，每个诊所都完成了一项调查，以评估与 NBS 相关的办公室系统，并完成了病历审核。为实践团队提供了有关 NBS 的信息，并进行了质量改进方法的培训，然后实施了改进措施以改善护理。在 6 个月的时间内每月进行病历审核，以评估变化。
在基线时，几乎一半的诊所都对新生儿进行了 NBS 评估；6 个月后，80%的诊所对所有新生儿都进行了评估。只有 2 家诊所记录了所有正常范围内的结果并在基线时与家长分享；到项目完成时，15 家诊所中有 10 家记录并分享了 70%以上新生儿的正常范围内的结果。在基线时，只有 15 家诊所中的 1 家使用了美国医学遗传学学院行动表（ACTion Sheets），一种决策支持工具，而在项目完成时，有 7 家使用了该工具。
实践在改善 NBS 流程方面取得了成功，包括评估、记录和与家庭的沟通。在实施改进流程后，提供者在首次就诊、2-4 周就诊或首次与有异常结果的新生儿家庭接触时，并未感觉到提供者时间增加。初级保健实践在项目实施后增加了决策支持工具的使用。
