Big Strides for Small Patients: Developmental Screening in

Pediatric Primary Care

Department of PediatricsJerold Stirling, MDRebecca Turk, MD

Melanie Arvanitakis, MSApril Gann, MS

Holly Nandan, MHA/MBA, CHE

Made possible by a grant from the Illinois Children’s Healthcare Foundation

Confidential: For Quality Improvement Purposes Only

The Opportunity…It is estimated that 16 percent of children have developmental and/or

behavioral disorders; however, only 30% of these disorders are identified before the child starts school. Many physicians use “Developmental Surveillance”, an informal developmental checklist, to monitor a child’s development.

The American Academy of Pediatrics (AAP) issued a policy statement in 2006, which recommended formal “Developmental Screening”, use of a formal standardized screening tool, to monitor development at 9, 18 and 24 month well-child visits. (1)

Prior to this project, a self-reported survey of Loyola physicians indicated

that 4.5% of these physicians used formal standardized “Developmental Screening” tools for well-child visits.

(1) Policy Statement-Identifying Infants and Young Children with Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening. Pediatrics, July 2006, 118-1, 405-420.

Confidential: For Quality Improvement Purposes Only

Aim StatementDevelop and implement an integrated, sustainable developmental

screening program for the children, ages 0-5, receiving primary pediatric care across Loyola University Health System

1. Achieve 75% compliance with “Developmental Screening” at designated well child visits

2. Provide education to improve knowledge and skills of pediatric health care providers Use of formal developmental screening tools Child development and behavior, family education, local community

resources

3. Increase appropriate and timely referrals to community resources Early intervention School Private therapy Community agencies

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Solutions Implemented Secured grant funding and hired 1.5 FTE Child Development Specialists Established a project Advisory Committee Surveyed physicians to determine existing developmental screening

practices across LUHS Researched options for Developmental Screening tools Built developmental screening resource webpage; added to the Dept of

Pediatrics site Developed Epic prompts & documentation

Developmental screening prompt in note Documentation of screening results Referral letter

Created implementation schedule for 11 sites Built relationships with community organizations to create referral

resource list

Confidential: For Quality Improvement Purposes Only

Site-Specific ImplementationPilot sites: LOC Pediatrics & North RiversidePLAN Meeting with site physicians

Share national statistics and AAP policy statement Discuss screening tool options Decide site-specific timing of screenings

Test Developmental Screenings with each physician Meeting with site manager/clinical coordinator

Plan work-flow changes Plan for staff education

Developed a site-specific toolkit and referral book Staff educationDO Implementation

On-site technical assistance with screenings and problem-solve workflow issuesSTUDY Chart reviews to monitor screeningsACT Follow-up meeting to discuss feedback and ways to improve screening process

Confidential: For Quality Improvement Purposes Only

Developmental Screening at Well-Child Visits Overall Project Results July 07 - March 08

All sites have achieved the 75% target

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

LOC Peds N River Wheaton Darien Maywood FP Glendale Elmhurst/OP Hickory Oak Brook Orland Pk

Per

cen

t C

om

pli

ance

Target: 75%

Confidential: For Quality Improvement Purposes Only

Post-Screening Referral Rate Overall Project Results July 07 - March 08

Overall referral rate post implementation is 10%

0%

5%

10%

15%

20%

25%

30%

35%

LOC Peds N River Wheaton Darien Maywood FP Glendale Elmhurst/OP Hickory Oak Brook Orland Pk

The post screening referral rate represents the percentage of patients who were identified as having developmental concerns. All patients who were identified as having developmental concerns were given referrals for further evaluation.

Confidential: For Quality Improvement Purposes Only

Analysis Project work exceeded targets:

89% overall rate for developmental screening 46 (100%) attending physicians were trained 10% overall rate for referrals

Appropriate training and tools enabled developmentally appropriate care to become standard in a short amount of time

Development of site-specific workflows and referral networks was successful in reducing barriers and resistance to implementation

System changes in Epic standardized processes and improved compliance

Added developmental screening component to Pediatric Residency education

Confidential: For Quality Improvement Purposes Only

Next Steps Continue site-specific chart reviews and technical

assistance Expand Loyola’s community referral network to

meet the developmental needs of all of our pediatric patients

Seek additional grant funding to implement expanded screening for autism, social-emotional development, maternal depression, and domestic violence/risk assessment

Explore opportunities to publish results as a role model to implement AAP recommendations for screening

Confidential: For Quality Improvement Purposes Only