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Randomized Controlled Trial
. 2014 Jun;133(6):e1664-75.
doi: 10.1542/peds.2013-1578. Epub 2014 May 5.

Practice-tailored facilitation to improve pediatric preventive care delivery: a randomized trial

Sharon B Meropol  1 , Nicholas K Schiltz  2 , Abdus Sattar  3 , Kurt C Stange  4 , Ann H Nevar  5 , Christina Davey  6 , Gerald A Ferretti  7 , Diana E Howell  6 , Robyn Strosaker  8 , Pamela Vavrek  5 , Samantha Bader  5 , Mary C Ruhe  9 , Leona Cuttler  10
Affiliations
Randomized Controlled Trial

Practice-tailored facilitation to improve pediatric preventive care delivery: a randomized trial

Sharon B Meropol et al. Pediatrics. 2014 Jun.

Abstract

Objective: Evolving primary care models require methods to help practices achieve quality standards. This study assessed the effectiveness of a Practice-Tailored Facilitation Intervention for improving delivery of 3 pediatric preventive services.

Methods: In this cluster-randomized trial, a practice facilitator implemented practice-tailored rapid-cycle feedback/change strategies for improving obesity screening/counseling, lead screening, and dental fluoride varnish application. Thirty practices were randomized to Early or Late Intervention, and outcomes assessed for 16 419 well-child visits. A multidisciplinary team characterized facilitation processes by using comparative case study methods.

Results: Baseline performance was as follows: for Obesity: 3.5% successful performance in Early and 6.3% in Late practices, P = .74; Lead: 62.2% and 77.8% success, respectively, P = .11; and Fluoride: <0.1% success for all practices. Four months after randomization, performance rose in Early practices, to 82.8% for Obesity, 86.3% for Lead, and 89.1% for Fluoride, all P < .001 for improvement compared with Late practices' control time. During the full 6-month intervention, care improved versus baseline in all practices, for Obesity for Early practices to 86.5%, and for Late practices 88.9%; for Lead for Early practices to 87.5% and Late practices 94.5%; and for Fluoride, for Early practices to 78.9% and Late practices 81.9%, all P < .001 compared with baseline. Improvements were sustained 2 months after intervention. Successful facilitation involved multidisciplinary support, rapid-cycle problem solving feedback, and ongoing relationship-building, allowing individualizing facilitation approach and intensity based on 3 levels of practice need.

Conclusions: Practice-tailored Facilitation Intervention can lead to substantial, simultaneous, and sustained improvements in 3 domains, and holds promise as a broad-based method to advance pediatric preventive care.

Trial registration: ClinicalTrials.gov NCT01739166.

Keywords: child; dental caries; lead poisoning; obesity; quality improvement.

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Figures

FIGURE 1
FIGURE 1
Flow diagram. aMore visits were included for Late-Phase practices because they had 4 months of control time before starting the intervention. FTE, full-time equivalent.
FIGURE 2
FIGURE 2
Obesity: detection and counseling performed.
FIGURE 3
FIGURE 3
Lead: appropriate screening performed.
FIGURE 4
FIGURE 4
Fluoride: varnish applied.
FIGURE 5
FIGURE 5
Building blocks for reaching high success rates with practice change.
FIGURE 6
FIGURE 6
A, Practice characteristics by facilitation intensity. B, Practice decision style: by facilitation intensity.
See this image and copyright information in PMC

References

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