Quality Improvement/Patient Safety: Primary & Subspecialty Outpatient Quality Improvement
QI 2: Screening in Primary Care
Kevin Fang, MD MPH (he/him/his)
Assistant Clinical Professor of Pediatrics
Children's Hospital Los Angeles
Los Angeles, California, United States
Quality improvement methodology was used to assess responses to the question “Do you regularly ask about school attendance in your well-child checks?”. Responses included ‘Yes’, ‘Sometimes’, and ‘No’. After a baseline survey, the first PDSA cycle of interventions included creating and implementing standardized school attendance screening questions into well-child templates in the Electronic Medical Record as well as a hospital-wide Grand Rounds. The second cycle of interventions included resident-specific talks on links between school and health, importance of screening, and how to screen patients.
Results:
Approximately 111 pediatric residents received the surveys with response rates of 15% (n=17) at baseline, 36% (n=40) after the first intervention, and 30% (n=33) after the second intervention. Almost 30% of those surveyed (n = 5) reported regularly asking about school attendance at baseline, which increased to 55% (n = 22) and 73% (n=24) after the first and second interventions, respectively. At baseline, more than a third of residents (n = 6) reported sometimes asking about school attendance, which decreased to 32.5% (n=13) and 24.2% (n=8), respectively. More than one-third of residents (n = 6) responded no at baseline, which decreased to 12.5% (n=5) and 3% (n=1), respectively. A significant difference between pre- and post-intervention responses was seen (p = 0.013).
Conclusion(s): This study highlights the impact of integrating standardized questions into the EMR to increase screening, however this alone was insufficient. The combination of implementation and focused education improved screenings rates further. While the goal of 80% regularly screening has not yet been attained, factoring in those who sometimes screen increases this to 97%. Next steps include identifying barriers to screening for this sub-group, comparing rates of absenteeism in our clinic to state and national data, and partnering with local schools to improve school attendance.