Children with developmental delays stand a better chance of getting the early-intervention services they need if clinicians take the time to document screening efforts and follow-up with a simple telephone call, investigators say.
When a large children's hospital in Denver, Colorado, ramped up its screening, referral, and follow-up efforts and implemented quality-control measures to verify the outcomes, the number of children referred to community resources more than doubled, and the number referred to early intervention programs trippled.
"Even in a clinic with high rates of developmental screening, we found that screening, identification, referral, and the use of a developmental screening template in the [electronic medical record] did not adequately facilitate access to [early intervention] services for children at risk for developmental delays," Ayelet Talmi, PhD, from the Department of Psychiatry and the Department of Pediatrics at the University of Colorado School of Medicine in Aurora, and colleagues write in an article published online September 1 in Pediatrics.
They came to that conclusion after a change in their practice in 2007, when they switched from the use of a developmental milestone template employed during well-child visits to a universal developmental screening program using the standardized Age & Stages Questionnaire, 3rd edition.
"Although our implementation efforts yielded high screening rates, rates of identification, referrals, and documentation of referral completion were considerably lower, even with ongoing training efforts and availability of onsite developmental specialists," they write.
Quality Improvement
During the following year, the clinic directors rolled out a quality improvement program to enhance the documentation of both the screening results and the referral process.
They began by inserting a developmental screening template into electronic medical record templates for each well-child visit, which would allow the systematic recording of screening results and referral actions taken by providers if the screening results were abnormal.
Although the system had a data-tracking capability that showed an improvement in documentation of screening, the investigators found that the clinic's pediatric providers "were predominantly using passive monitoring, documenting evaluation and eligibility for services if and when families returned to clinic and reported outcomes to providers. When they returned for a follow-up visit, families frequently reported a breakdown between the referral from primary care and uptake of [early-intervention] services, indicating no connection with the [early-intervention] system, despite having been referred," the authors found.
To address this problem, the directors told the providers to schedule an interim follow-up visit (before the next scheduled well-child visit) specifically to assess developmental progress and make referrals if necessary.
They also instituted a follow-up telephone call to families of children who had abnormal screening results but for whom referral status was unclear. The callers could discuss the screening findings with the parents/caregivers, determine whether an early intervention referral had been made, and if necessary, make a referral.
In addition, provider documentation of early-intervention outcomes doubled, going from 15% when the screening template alone was used to 31% when a follow-up telephone call was added.
"Importantly, in the context of a medical home, pediatric providers need to know about, discuss with families, and document the child's involvement with community services. Our findings suggest that ongoing efforts may be required to promote pediatric providers' gathering and documenting developmental screening referral outcomes," they write.
The study was supported by the Irving Harris Program in Child Development and Infant Mental Health, Children's Hospital Colorado, Children's Outcomes Research Program, and Colorado Health Outcomes Program. The authors have disclosed no relevant financial relationships.
Pediatrics. Published online September 1, 2014.
This article is exactly why I would Like ACES screening as a MOC (QI) project!!!!!
http://www.medscape.com/viewarticle/830706?src=rss
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