Big Strides for Small Patients: Developmental Screening in Pediatric Primary Care Department of Pediatrics Jerold Stirling, MD Rebecca Turk, MD Melanie Arvanitakis, MS April Gann, MS Holly Nandan, MHA/MBA, CHE Made possible by a grant from the Illinois Children’s Healthcare Foundation Confidential: For Quality Improvement Purposes Only

The Opportunity… It is estimated that 16 percent of children have developmental and/or behavioral disorders; however, only 30% of these disorders are identified before the child starts school. Many physicians use “Developmental Surveillance”, an informal developmental checklist, to monitor a child’s development. The American Academy of Pediatrics (AAP) issued a policy statement in 2006, which recommended formal “Developmental Screening”, use of a formal standardized screening tool, to monitor development at 9, 18 and 24 month well-child visits. (1) Prior to this project, a self-reported survey of Loyola physicians indicated that 4.5% of these physicians used formal standardized “Developmental Screening” tools for well-child visits. (1) Policy Statement-Identifying Infants and Young Children with Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening. Pediatrics, July 2006, 118-1, Confidential: For Quality Improvement Purposes Only

Aim Statement Develop and implement an integrated, sustainable developmental screening program for the children, ages 0-5, receiving primary pediatric care across Loyola University Health System 1. Achieve 75% compliance with “Developmental Screening” at designated well child visits 2. Provide education to improve knowledge and skills of pediatric health care providers Use of formal developmental screening tools Child development and behavior, family education, local community resources 3. Increase appropriate and timely referrals to community resources Early intervention School Private therapy Community agencies Confidential: For Quality Improvement Purposes Only

Solutions Implemented Secured grant funding and hired 1.5 FTE Child Development Specialists Established a project Advisory Committee Surveyed physicians to determine existing developmental screening practices across LUHS Researched options for Developmental Screening tools Built developmental screening resource webpage; added to the Dept of Pediatrics site Developed Epic prompts & documentation Developmental screening prompt in note Documentation of screening results Referral letter Created implementation schedule for 11 sites Built relationships with community organizations to create referral resource list Confidential: For Quality Improvement Purposes Only

Site-Specific Implementation Pilot sites: LOC Pediatrics & North Riverside PLAN Meeting with site physicians Share national statistics and AAP policy statement Discuss screening tool options Decide site-specific timing of screenings Test Developmental Screenings with each physician Meeting with site manager/clinical coordinator Plan work-flow changes Plan for staff education Developed a site-specific toolkit and referral book Staff education DO Implementation On-site technical assistance with screenings and problem-solve workflow issues STUDY Chart reviews to monitor screenings ACT Follow-up meeting to discuss feedback and ways to improve screening process Confidential: For Quality Improvement Purposes Only

Target: 75% Confidential: For Quality Improvement Purposes Only

The post screening referral rate represents the percentage of patients who were identified as having developmental concerns. All patients who were identified as having developmental concerns were given referrals for further evaluation. Confidential: For Quality Improvement Purposes Only

Analysis Project work exceeded targets: 89% overall rate for developmental screening 46 (100%) attending physicians were trained 10% overall rate for referrals Appropriate training and tools enabled developmentally appropriate care to become standard in a short amount of time Development of site-specific workflows and referral networks was successful in reducing barriers and resistance to implementation System changes in Epic standardized processes and improved compliance Added developmental screening component to Pediatric Residency education Confidential: For Quality Improvement Purposes Only

Next Steps Continue site-specific chart reviews and technical assistance Expand Loyola’s community referral network to meet the developmental needs of all of our pediatric patients Seek additional grant funding to implement expanded screening for autism, social-emotional development, maternal depression, and domestic violence/risk assessment Explore opportunities to publish results as a role model to implement AAP recommendations for screening Confidential: For Quality Improvement Purposes Only