239 - Improving quality metrics for adolescents: lessons learned from a Clinically Integrated Network’s regional quality improvement initiative

Poster Number: 239
Publication Number: 239.451

Claire O. Boogaard, Children's National Hospital, Washington, DC, United States; Charlotte Harper, Children's National Health System, Hyattsville, MD, United States; Eduardo R. Fox, George Washington University School of Medicine and Health Sciences, Washington, DC, United States; Erica Weiner, Children's National Health System, Silver Spring, MD, United States; Terry L. Terry, Children's National Health System, Oakwood, OH, United States; Mark Weissman, Children's National Hospital, George Washington University, Washington, DC, United States

Background: The Pediatric Health Network is a clinically integrated network in the mid-Atlantic region focused on improving the quality of pediatric health care delivery through quality improvement initiatives.  Given the national focus on adolescent mental health and our local payor focus on adolescent metrics, a systematic, evidence-based initiative was developed to improve care for this population.

Objective: Implement collective changes at primary care pediatric practices with aims of improving rates of depression screening, vaccination completion, and social determinants of health (SDOH) screening for patients 13-21 years old by 10% from baseline. (Table 1)

Design/Methods: 26 pediatric practices regularly participated in the project from March 2022- September 2022. The initiative consisted of a baseline survey and data analysis followed by three PDSA cycles with associated data collection.  Practice participants designed their own PDSA cycles, focused on improving one or more of the metrics.  Standardized coding strategies to capture results were recommended.  Cycle data was collected by practice leaders by chart review and reported in a REDCap survey.  Practice leaders met every other month to review data and share best practices.  Educational seminars by topic experts were offered to p</span>articipants three times throughout the project.

Results: All three metrics improved from baseline.  Depression screening metric had an 8% overall improvement and a 71% increase in screens coded by recommendation; adolescent vaccine metric had a 4% improvement from baseline; SDOH metric showed a 13% improvement in screening from baseline and a 44% increase in screens coded by recommendation (Figure 1).  Interventions for improved screenings included educating providers/billing teams; adjusting screening tools, templates, and workflows for easier administration; and automating appropriate coding in the electronic medical record (EMR).  Vaccination improvement interventions included strategies to educate patient and family on safety and efficacy of vaccine; provider training on best practices for vaccination and communication; and system adjustments to initiate patient outreach for those with gaps or starting HPV series before age 11 years. 

Conclusion(s): Collective PDSA cycles across a regional clinically integrated network can lead to improvement outcome measures for adolescents and processes to track those metrics.