Published online August 28, 2006
PEDIATRICS Vol. 118 No. 4 October 2006, pp. e1039-e1047 (doi:10.1542/peds.2005-2699)
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ARTICLE

Statewide Quality Improvement Outreach Improves Preventive Services for Young Children

Judith S. Shaw, RN, MPH, Richard C. Wasserman, MD, MPH, Sara Barry, MPH, Thomas Delaney, PhD, Paula Duncan, MD, Wendy Davis, MD and Patricia Berry, MPH

Department of Pediatrics, University of Vermont College of Medicine, Vermont Department of Health, Burlington, Vermont

OBJECTIVE. Although clinical trials demonstrate the efficacy of quality improvement outreach in improving service delivery, evidence for broad community effectiveness has been lacking. The objective of this study was to test the effectiveness of a statewide pediatric quality improvement outreach program in improving preventive services for children who are younger than 5 years.

METHODS. All pediatric practices in Vermont (n = 35) were invited to participate in a preventive services quality improvement initiative. Ninety-one percent agreed. Participating practices serve >80% of all Vermont children who are younger than 5 years. The main outcome measured was change in 9 preventive services areas: (1) immunizations up to date; (2) anemia screening; (3) tuberculosis risk assessment and indicated screening; (4) lead screening; (5) infant sleep position counseling; (6) environmental tobacco smoke–exposure risk assessment; (7) blood pressure screening; (8) vision screening; and (9) dental risk assessment.

RESULTS. All practices demonstrated improvement in 1 or more preventive services areas. The mean number of areas chosen was 5 (range: 1–9). Practices that selected a specific preventive service area as a quality improvement goal were more likely to demonstrate improvement in that area than practices that did not choose to focus on that preventive services area.

CONCLUSIONS. The work in this project has provided the evidence for an effective statewide pediatric quality improvement outreach program to improve preventive services for children who are younger than 5 years. Practices' decision to focus on a specific preventive service area as a quality improvement goal seems necessary for improvement in that area. This approach may be effective in other states or regions.

Key Words: preventive services • well-child care • quality improvement • immunizations • screening • maternal and child health

Abbreviations: QI—quality improvement • VPSI—Vermont Preventive Services Initiative • VCHIP—Vermont Child Health Improvement Program • VDH—Vermont Department of Health • AAP-VT—American Academy of Pediatrics, Vermont chapter • NICHQ—National Initiative for Children's Healthcare Quality • LS—learning session • PDSA—plan-do-study-act

Accepted Apr 27, 2006.


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E. J. Slora, J. M. Steffes, D. Harris, H. W. Clegg, D. Norton, P. M. Darden, S. A. Sullivan, and R. C. Wasserman
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[Abstract] [PDF]