Published online July 1, 2008
PEDIATRICS Vol. 122 No. 1 July 2008, pp. e163-e171 (doi:10.1542/peds.2007-2700)
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ARTICLE

The Bright Futures Training Intervention Project: Implementing Systems to Support Preventive and Developmental Services in Practice

Carole M. Lannon, MD, MPHa, Kori Flower, MD, MPHb, Paula Duncan, MDc, Karen Strazza Moore, MPHd, Jayne Stuart, MPHe and Jane Bassewitz, MAf

a Center for Health Care Quality, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
b Piedmont Health Services, Inc, Carrboro, North Carolina
c Department of Pediatrics, University of Vermont, Burlington, Vermont
d Injury Prevention Research Center, University of North Carolina, Chapel Hill, North Carolina
e Stuart Consulting, Hillsborough, North Caroina
f American Academy of Pediatrics, Elk Grove Village, Illinois

OBJECTIVES. The objectives of this study were to assess the feasibility of implementing a bundle of strategies to facilitate the use of Bright Futures recommendations and to evaluate the effectiveness of a modified learning collaborative in improving preventive and developmental care.

METHODS. Fifteen pediatric primary care practices from 9 states participated in a 9-month learning collaborative. Support to practices included a toolkit, 2 workshops, training in quality-improvement methods, monthly conference calls and data feedback, and a listserv moderated by faculty. Aggregated medical chart reviews and practice self-assessments on 6 key office system components were compared before and after the intervention.

RESULTS. Office system changes most frequently adopted were use of recall/reminder systems (87%), a checklist to link to community resources (80%), and systematic identification of children with special health care needs (80%). From baseline to follow-up, increases were observed in the use of recall/reminder systems, the proportion of children's charts that had a preventive services prompting system, and the families who were asked about special health care needs. Of 21 possible office system components, the median number used increased from 10 to 15. Comparing scores between baseline and follow-up for each practice site, the change was significant. Teams reported that the implementation of office systems was facilitated by the perception that a component could be applied quickly and/or easily. Barriers to implementation included costs, the time required, and lack of agreement with the recommendations.

CONCLUSIONS. This project demonstrated the feasibility of implementing specific strategies for improving preventive and developmental care for young children in a wide variety of practices. It also confirmed the usefulness of a modified learning collaborative in achieving these results. This model may be useful for disseminating office system improvements to other settings that provide care for young children.

Key Words: developmental screening • preventive care • practice improvement • performance measurement • collaborative learning

Abbreviations: AAP—American Academy of Pediatrics • BFTIP—Bright Futures Training Intervention Project • PSPS—preventive services prompting system • SDA—structured developmental assessment • CSHCN—children with special health care needs • OSI—office systems inventory

Accepted Feb 25, 2008.


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