Utilizing a quality improvement program to influence screening rates


Screenings are an important way to ensure that children get referred to necessary care, but gaps still remain. A new study reports on whether a quality program improved screening rates.

Screenings in childhood are instrumental to finding issues before they become problems as well as mitigate any ill effects. Unfortunately, gaps can remain that prevent children from receiving all recommended screenings. An investigation in Pediatrics looks at whether a quality collaborative improvement program led to multiple improvements.1

The collaborative included 19 pediatric primary care practices across the United States and ran for a year. The team at each practice implemented changes to the early childhood screenings. Each team was given both virtual and in-person learning opportunities. A monthly chart review helped assess screening, discussion, referral, and follow-up for development, autism spectrum disorder, maternal depression, and social determinants of health. Practice-level changes were measured by practice self-ratings and team surveys. Surveys administered to parents assessed parent-reported screening and referral as well as resource provision.

The practices who participated in the quality improvement collaborative ranged from independent, hospital-affiliated, multispecialty group practices, academic, and community health centers and they were located in 12 states. Overall, the collaborative was able to meet both the development and autism spectrum disorder screening goals by 90% at the end of the study period. The largest increases in screening were found in social determinants of health SDoH (26% to 76%; +231%; P < .001) as well as maternal depression (27% to 87%; +222%; P < .001). Additionally, discussion of results saw statistically significant increases in all of the screening areas. In referrals, there were significant increases seen for both maternal depression (23% to 100%; P = .008) and development (53% to 86%; P < .001). Changes seen at the practice level encompassed improved systems that supported screening. The parents of patients also said that they had seen increased screenings and referrals as well as resource provision.

The researchers concluded that the program had been able to successfully improve how screenings were used and when they were used, which closed previous gaps. This improvement in screenings also led to improvement in the rate of discussion of the screening results, referral to necessary services, and any other follow-up steps. They said that continuing to push for the needed resources to support referrals and follow-up are needed to continue meeting screening gaps.


1. Flower K, Massie S, Janies K, et al. Increasing early childhood screening in primary care through a quality improvement collaborative. Pediatrics. August 7, 2020. Epub ahead of print. doi:10.1542/peds.2019-2328

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