692 - Milestones Matter: Using “Milestone Toolkits” to Improve Parental and Provider Recognition of Delays and Reduce Early Intervention (EI) Disparities

Poster Number: 692
Publication Number: 692.152

Nancy J. Lee, Weill Cornell Medicine, Long Island City, NY, United States; Brittany Watchmaker, Weill Cornell Medicine, New York, NY, United States; Erika Abramson, NewYork-Presbyterian Komansky Children’s Hospital, Rye Brook, NY, United States; Snezana Nena Osorio, Weill Cornell Medical College, New York, NY, United States

Background: Literature suggests that initiation of appropriate services through Early Intervention (EI) is key to improved long-term developmental outcomes. Increased time to diagnosis and lower rates of EI referral disproportionately affect low socio-economic status (SES) and non-English speaking children, yet there is a paucity of literature on methods to mitigate disparities in EI referral practices.

Objective: Our aim was to improve EI referral rate of eligible patients from pre-pandemic baseline (3%) to the national rate of children with at least one developmental delay (15%).

Design/Methods: A resident-led Quality Improvement (QI) study utilized planned sequential experimentation to test a multiprong intervention “Milestones Matter” (Figure 1, Driver Diagram) on a family of measures including outcomes (parent-reported completion of EI evaluation and parental satisfaction) and processes (Milestone toolkit distribution and EI referral). The toolkit included an age-appropriate milestone card (available in English, Spanish, Bengali, Arabic) with tips for promoting development and a developmentally appropriate item to take home (Figure 1). All eligible patients aged 0-36 months seen in a primary care clinic serving low-SES and many non-English speaking patients were included. Parental satisfaction was assessed via 7-item survey. Parent-reported anxiety regarding detection of development delays was the balancing measure. Run chart rules and Associates in Process Improvement (API) rules were applied to detect signal of change and special cause variation, while descriptive statistics was used to analyze survey data.

Results: Milestone Toolkit distribution rate was high (86%, Figure 2); 80% of parents answered “yes” to learning from the Milestone Toolkit (n = 67). EI referral rate was improved from 3 to 6% (Figure 3). Self-reported completion of EI evaluation was 74%. Of 36 EI-referred patients post-intervention, 9 declined the evaluation while 2 aged out. Out of 20 parents, only 2 reported anxiety/stress after receiving a Toolkit.

Conclusion(s):

Referral rates to EI doubled after initiation of the Milestones Matter intervention, suggesting that this intervention may help improve parental and provider recognition of developmental delays, including in low SES and non-English speaking patients. Parental decline of EI services proves a major obstacle in timely evaluation of delays, and future efforts will focus on addressing parental hesitation.