Standardizing early child development screening in a federally qualified health center: a quality improvement project

Abstract

Background: Pediatric developmental screening is an important component of well-child care, useful in detecting the one in six children who have disabilities. Just over 30% of children nationwide receive behavioral and developmental screening; surveillance alone can miss up to 50% of developmental concerns in early childhood, which if identified and treated early can lead to better outcomes. Local Problem: At a rural Federally Qualified Health Center, providing primary care in southcentral Montana, standardized pediatric developmental screening does not occur. Developmental screening of 100% of children is recommended by the American Academy of Pediatrics, Healthy People 2030, and Centers for Medicare & Medicaid Services. Methods: Participants included pediatric patients ages 2-months to 36-months presenting to the clinic for well-child visits. Intervention outcomes measured biweekly throughout the six-week initiative included: developmental screening rates, electronic medical record (EMR) screening documentation by nursing staff, and correct administration of indicated screening tools. Interventions: Literature supported standardized screening tool implementation, such as the Ages and Stages Questionnaire and Modified Checklist for Autism in Toddlers coupled with practice-wide engagement. Interventions included staff and provider education, visual reminders, EMR documentation templates, and implementation of a clear staff workflow. Results: A total of 25 pediatric patients meeting screening eligibility presented to the clinic during the quality improvement project. Screening rates were improved to 80% from a baseline of zero, with 85% of patients receiving the correct screener. Conclusion: Implementing a screening tool and standardizing workflow processes combined with education, EMR utilization, and visual reminders improved pediatric development screening rates.