Children's Health

Continued staff education and improved processes in physicians' offices can enhance preventive care for children

A practice-based, team approach involving education and coaching of medical office staff in quality improvement expertise—such as chart screening—can improve the delivery of preventive care for children, according to the first randomized controlled trial on the topic. The research was supported in part by the Agency for Healthcare Research and Quality (HS08509).

Peter Margolis, M.D., Ph.D., of the University of North Carolina, Chapel Hill, and his colleagues randomly assigned a sample of 44 practices to intervention and control groups. They compared change over time in the proportion of children aged 24-30 months who received age-appropriate care for four preventive services: immunizations and screening for tuberculosis, anemia, and lead.

The proportion of children per practice with age-appropriate delivery of all four preventive services changed after a 1-year period, from 7 to 34 percent in intervention practices and from 9 to 10 percent in control practices. After adjustment for baseline differences in the groups, the change in prevalence of all four services between the beginning and end of the study was 4.6-fold greater in intervention practices than in control practices.

Thirty months after baseline, the proportion of children who were up to date with preventive services was higher in intervention than in control practices. Screening rates were significantly higher in intervention practices than in control practices for tuberculosis (54 vs. 32 percent), lead (68 vs. 30 percent), and anemia (79 vs. 71 percent). Continuing education combined with process improvement methods to implement office systems is an effective approach for increasing rates of delivery of preventive care to children, conclude the researchers.

See "Practice based education to improve delivery systems for prevention in primary care: Randomised trial," by Dr. Margolis, Carole M. Lannon, M.D., M.P.H., Jayne M. Stuart, M.P.H., and others, in the February 14, 2004, British Medical Journal 328, pp. 388-394.

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