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. 2012 Oct;130(4):e988-95.
doi: 10.1542/peds.2012-0355. Epub 2012 Sep 17.

Improving delivery of EPSDT well-child care at acute visits in an academic pediatric practice

Barron L Patterson  1 , William M Gregg, Cynthia Biggers, Shari Barkin
Affiliations

Improving delivery of EPSDT well-child care at acute visits in an academic pediatric practice

Barron L Patterson et al. Pediatrics. 2012 Oct.

Abstract

Background and objective: Many patients with Medicaid do not receive timely, comprehensive well-child care through the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program. Missed opportunities for EPSDT well-child check-ups (WCCs) at acute visits contribute to this problem. The authors sought to reduce missed opportunities for WCCs at acute visits for patients overdue for those services.

Methods: A quality improvement team developed key drivers and used a people-process-technology framework to devise 3 interventions: (1) an electronic indicator based on novel definitions of EPSDT status (up-to-date, due, overdue, no EPSDT), (2) a standardized scheduling process for acute visits based on EPSDT status, and (3) a dedicated nurse practitioner to provide WCCs at acute visits. Data were collected for 1 year after full implementation.

Results: At baseline, 10.3 acute visits per month were converted to WCCs. After intervention, 86.7 acute visits per month were converted. Of 13801 acute visits during the project, 31.2% were not up-to-date. Of those overdue for WCCs, 51.4% (n = 552) were converted to a WCC in addition to the acute visit. Including all patients who were not up-to-date, a total of 1047 acute visits (7.6% of all acute visits) were converted to comprehensive WCCs. Deferring needed WCCs at acute visits resulted in few patients who scheduled or completed future WCC visits.

Conclusions: Implementation of interventions focused on people-process-technology significantly increased WCCs at acute visits within a feasible and practical model that may be replicated at other academic general pediatrics practices.

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Conflict of interest statement

FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose. Drs Patterson and Barkin and Ms Biggers have no conflicts of interest to disclose. Dr Gregg reports a conflict of interest outside of the submitted work. The software used in this project, StarPanel, which is the electronic medical record for Vanderbilt University Medical Center has been licensed to Informatics Corporation of America (ICA), which markets a version of the software. Dr Gregg is listed as one of the inventors under the licensing agreement and does occasional consulting work for ICA.

Figures

FIGURE 1. Key drivers. WCC is synonymous with comprehensive EPSDT screening exam.
FIGURE 1
Key drivers. WCC is synonymous with comprehensive EPSDT screening exam.
FIGURE 2. Pediatrics preventive dashboard including color-coded EPSDT status indicator.
FIGURE 2
Pediatrics preventive dashboard including color-coded EPSDT status indicator.
FIGURE 3. Scheduling process for acute visits for patients based on EPSDT status. Note: resident physicians were asked to do WCCs at acute visits if the NP was not available.
FIGURE 3
Scheduling process for acute visits for patients based on EPSDT status. Note: resident physicians were asked to do WCCs at acute visits if the NP was not available.
FIGURE 4. Run chart for number of weekday acute visits converted to WCCs for patients ≥2 months old. The x-axis shows month, year, and total acute visits for patients ≥2 months old.
FIGURE 4
Run chart for number of weekday acute visits converted to WCCs for patients ≥2 months old. The x-axis shows month, year, and total acute visits for patients ≥2 months old.
FIGURE 5. Project flowchart by EPSDT status, future appointment status, and WCC conversion status.
FIGURE 5
Project flowchart by EPSDT status, future appointment status, and WCC conversion status.
See this image and copyright information in PMC

References

    1. Centers for Medicare and Medicaid Services. Early and periodic screening diagnosis & treatment. Available at: www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Benefits/Ea.... Accessed January 17, 2012
    1. Maternal and Child Health Bureau. EPSDT & Title V collaboration to improve child health. Available at: mchb.hrsa.gov/epsdt/index.html. Accessed January 17, 2012
    1. Peters CP . EPSDT: Medicaid’s critical but controversial benefits program for children. NHPF Issue Brief. 2006; (819):1–24 - PubMed
    1. Pittard WB III , Laditka JN , Laditka SB . Early and periodic screening, diagnosis, and treatment and infant health outcomes in Medicaid-insured infants in South Carolina. J Pediatr. 2007;151(4):414–418 - PubMed
    1. Hakim RB , Bye BV . Effectiveness of compliance with pediatric preventive care guidelines among Medicaid beneficiaries. Pediatrics. 2001;108(1):90–97 - PubMed

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