From Department of Family Medicine, University of Michigan, Ann Arbor, MI (TW, MDF); Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, University of Pittsburgh Medical Center Shadyside, PA (MS); Sapporo Tokushu-kai Hospital, Sapporo, Japan (UN, MS).
J Am Board Fam Med. 2018 Jul-Aug;31(4):558-569. doi: 10.3122/jabfm.2018.04.170222.
Early Periodic Screening, Diagnosis, and Treatment visits are designed to address physical, mental, and developmental health of children enrolled in Medicaid.
We conducted a mixed methods intervention by using a quality improvement theory. We assessed preintervention and postintervention screening rates of development, anemia, lead, oral health, vision and hearing, interventions for improvement, and barriers for the well-child visits at an academic family medicine clinic. For quantitative analysis, we assessed the preintervention baseline for 183 children and postintervention outcome for 151 children. For qualitative analysis, we used group interviews and key informant interviews to develop interventions in the preintervention stage and to explore potential barriers for further improvement in the postintervention stage.
Interventions based on baseline results included user-friendly materials, checklists, posters, education, and order sets. After the intervention, there were significant statistical improvements ( < .05) for the anemia test ordered rate, serum lead test ordered rate, oral health screening and referral rates, and ordered and confirmed test rates for both vision and hearing. Despite these improvements, 3 qualitative findings indicated barriers for further improvement, including difficulties in venipuncture, medical assistant aversion to vision screening, and poor fit of equipment for hearing assessment. The procedures prompted further continuous quality improvement activities using fingerstick hemoglobin testing, a child-friendly vision screener, and manual audiometer with headphones.
The trial findings demonstrated potential benefits of improving screenings in an office-based intervention by using a quality improvement process. Postintervention qualitative findings illustrate additional factors that could be addressed for further improvements.
早期定期筛查、诊断和治疗访问旨在解决参加医疗补助计划的儿童的身体、心理和发育健康问题。
我们采用质量改进理论进行了混合方法干预。我们评估了学术家庭医学诊所的儿童定期健康检查的发育、贫血、铅、口腔健康、视力和听力筛查率、改善干预措施以及儿童健康检查的障碍。为了进行定量分析，我们评估了 183 名儿童的干预前基线和 151 名儿童的干预后结果。为了进行定性分析，我们使用小组访谈和关键知情人访谈，在干预前阶段制定干预措施，并探讨干预后阶段进一步改进的潜在障碍。
基于基线结果的干预措施包括用户友好型材料、检查表、海报、教育和医嘱集。干预后，贫血测试医嘱率、血清铅测试医嘱率、口腔健康筛查和转诊率以及视力和听力的医嘱和确认测试率均有显著统计学改善（<0.05）。尽管有这些改善，但 3 项定性发现表明存在进一步改进的障碍，包括静脉穿刺困难、医疗助理对视力筛查的反感以及听力评估设备不匹配。这些程序促使使用指尖血红蛋白检测、儿童友好型视力筛查仪和带耳机的手动听力计进一步开展持续质量改进活动。
试验结果表明，通过质量改进流程，在基于办公室的干预中改善筛查具有潜在益处。干预后定性发现说明了可进一步解决以进一步提高的其他因素。
