1. Quality Improvement in Rural Primary Care Practices
Lichtfuss, Ellis; Mouton, Elizabeth; Sohl, Kristin MD; Curran, Alicia; Bopp, Kenneth
University of Missouri, Health Management & Informatics
Quality Improvement in Rural Primary Care Practices Do
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Background
In the U.S. approx. 13% of children age 3-17 have a developmental or behavioral disability (CDC, 2017)
There is vast evidence that early intervention can greatly enhance the lives of children with developmental delays and disabilities, yet current practice continues to lag behind research, and integration of routine developmental screening into the pediatric primary care setting is still an unrealized goal (Pinto-Martin, 2005)
In addition to the challenge of implementing developmental screening, many primary care practices struggle to implement any type of Quality Improvement (QI) projects into their practice
Quantitative Findings:
Overall, screening rates & PDSAs improved over the three month period for physicians participating in ECHO Autism
18 month MCHATs: 9 out of 15 physicians improved overall
24 month MCHATs: 10 out of 15 physicians improved overall
18 month General Development: 7 out of 15 physicians improved overall
24 month General Development: 7 out of 15 physicians improved overall
Physicians utilizing PDSA increased from 0 to 5 over 3 mos.
Qualitative findings:
ECHO has been beneficial in streamlining processes
Examples: giving patients screening tools before their appointment, huddles with staff frequently, making changes with new research and practices
Key barriers to QI Implementation identified by phone survey
Resistance to change
Difficulty developing/implementing new processes
Non-compliant staff
Patient barriers
Results
Barriers to Screening Implementation
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Objective
To increase developmental screening rates through the ECHO training model in pediatric primary care settings so that a greater number of children can reap the benefits of early intervention
To determine the effectiveness of the ECHO training model in increasing developmental screening rates by PCPs
To identify major barriers in implementation of developmental screening and other QI initiatives
To suggest best practice for implementation of developmental screening and QI projects in rural primary care practices
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January
Conclusions
The ECHO Autism model is effective in increasing screening rates for physicians in rural clinics
Allows physicians to streamline processes and make changes within the clinic to improve adherence to best practice guidelines, leading to enhanced patient care
Educating PCPs about QI tools such as PDSA increased implementation of QI initiatives in the practice of participating physicians
Methods
Through the use of Survey Monkey, data on the number of 18 and 24 month well child checks, MCHATs, and developmental screeners completed during each month was reported for each physician
Qualitative information was obtained through brief phone calls with 3 participating providers
This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant #T73MC00022, Missouri LEND. This information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.

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