Children's Health

Office-based quality improvement programs can substantially improve delivery of pediatric preventive services

Preventive care services such as immunizations and vision screening are the cornerstone of pediatric primary care, yet the rate at which doctors provide preventive care to children falls far below national goals. The good news is that office-based quality improvement (QI) systems can significantly improve the delivery of childhood preventive services, according to a study supported by the Agency for Healthcare Research and Quality (HS08509).

Peter A. Margolis, M.D., Ph.D., and colleagues at the University of North Carolina at Chapel Hill had project teams work with practice QI teams in eight primary care practices caring for children to develop tailored systems to assess and improve the delivery of immunizations and screening for anemia, tuberculosis, and lead exposure. These office-based QI systems typically involved some combination of chart prescreening and tagging of needed preventive care by staff before the patient saw the doctor, risk-assessment forms, flowsheets (for example, indicating age-specific preventive services), reminder/recall systems (usually computerized systems that identified patients who were not up to date on preventive care), and patient education materials. In some offices, parents were provided with laminated cards showing their child's immunization schedule to review before seeing the doctor. This served to remind both parents and doctors about needed immunizations.

Overall, the proportion of children who had complete immunizations improved 7 percent within 1 year after the QI system became operational and 12 percent 2 years later. Anemia screening improved 30 percent and lead screening 36 percent. There was no substantial increase in age-appropriate TB screening. However, the amount of improvement achieved in these areas varied considerably between practices. Those most likely to improve rates of a particular preventive service typically were practices that decided to target that particular service and had the overall ability to develop and implement new systems.

See "Improving preventive service delivery through office systems," by W. Clayton Bordley, M.D., M.P.H., Dr. Margolis, Jayne Stuart, M.P.H., and others, in the September 2001 Pediatrics 108(3).

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