Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Boston, Massachusetts;
Harvard Medical School, Harvard University, Boston, Massachusetts; and.
Pediatrics. 2018 Jul;142(1). doi: 10.1542/peds.2017-4017. Epub 2018 Jun 6.
Timely provision of developmental services can improve outcomes for children 0 to 3 years old with developmental delays. Early Intervention (EI) provides free developmental services to children under age 3 years; however, data suggests that many children referred to EI never connect to the program. We sought to ensure that 70% of patients referred to EI from an academic primary care clinic serving a low-income population were evaluated within 120 days of referral.
Recognizing that our baseline system of EI referrals had multiple routes to referral without an ability to track referral outcome, we implemented a multifaceted referral process with (1) a centralized electronic referral system used by providers, (2) patient navigators responsible for processing all EI referrals submitted by providers, and (3) a tracking system postreferral to facilitate identification of patients failing to connect with EI.
The percentage of patients evaluated by EI within 120 days increased from a baseline median of 50% to a median of 72% after implementation of the systems ( = 309). After implementation, the centralized referral system was used a median of 90% of the time. Tracking of referral outcomes revealed decreases in families refusing evaluations and improvements in exchange of information with EI.
Rates of connection to EI improved substantially when referrals were centralized in the clinic and patient navigators were responsible for tracking referral outcomes. Knowledge of EI intake processes and relationships between the practice and the EI site are essential to ensure successful connections.
及时提供发育服务可以改善 0 至 3 岁发育迟缓儿童的结局。早期干预(EI)为 3 岁以下儿童提供免费的发育服务;然而,数据表明,许多被推荐到 EI 的儿童从未与该项目建立联系。我们的目标是确保从一家为低收入人群服务的学术初级保健诊所推荐到 EI 的 70%的患者在推荐后 120 天内接受评估。
认识到我们的 EI 推荐基线系统有多种推荐途径,而无法跟踪推荐结果,我们实施了一个多方面的推荐流程,包括(1)供医者使用的集中电子推荐系统,(2)负责处理所有由供医者提交的 EI 推荐的患者导航员,以及(3)推荐后的跟踪系统,以方便识别未能与 EI 建立联系的患者。
在实施系统后,接受 EI 评估的患者比例从基线中位数的 50%增加到中位数的 72%(=309)。实施后,集中推荐系统的使用中位数达到了 90%。对推荐结果的跟踪显示,拒绝评估的家庭数量减少,与 EI 交换信息的情况有所改善。
当推荐在诊所集中化,患者导航员负责跟踪推荐结果时,与 EI 的连接率显著提高。了解 EI 的摄入流程以及实践与 EI 地点之间的关系对于确保成功连接至关重要。