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. 2023 Jul 10;8(4):e662.
doi: 10.1097/pq9.0000000000000662. eCollection 2023 Jul-Aug.

Using Quality Improvement to Design Early Childhood Services Navigation in Primary Care

Amy L King  1 , Courtney M Brown  2   3 , Cynthia C White  1 , Kristen A Copeland  1   4
Affiliations

Using Quality Improvement to Design Early Childhood Services Navigation in Primary Care

Amy L King et al. Pediatr Qual Saf. .

Abstract

Enrollment in high-quality early childhood education (ECE) improves educational and health outcomes and can mitigate racial and economic disparities. Pediatricians are encouraged to promote ECE yet lack the time and knowledge to assist families effectively. In 2016, our academic primary care center hired an ECE Navigator to promote ECE and help families enroll. Our SMART aims were to increase the number of children with facilitated referrals to high-quality ECE programs from 0 to 15 per month and to confirm enrollment on a subset to achieve an enrollment rate of 50% by December 31, 2020.

Methods: We used the Institute for Healthcare Improvement's Model for Improvement. Interventions included system changes in partnership with ECE agencies (eg, interactive map of subsidized preschool options, streamlined enrollment forms), case management with families, and population-based approaches to understand families' needs and the program's overall impact. We plotted the number of monthly facilitated referrals and the percentage of referrals enrolled on run and control charts. We used standard probability-based rules to identify special causes.

Results: Facilitated referrals increased from 0 to 29 per month and remained above 15. The percentage of enrolled referrals increased from 30% to 74% in 2018, then decreased to 27% in 2020 when childcare availability declined during the pandemic.

Conclusions: Our innovative ECE partnership improved access to high-quality ECE. Interventions could be adopted in part or whole by other clinical practices or WIC offices to equitably improve early childhood experiences for low-income families and racial minorities.

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Conflict of interest statement

Disclosures: Amy King is under contract with 4C for Children, a local childcare resource and referral agency in Cincinnati, Ohio, and Child Guidance & Family Solutions, a mental health agency in Akron, Ohio. The other authors have no conflicts of interest to declare in relation to the content of this article. This work has been supported by a grant from United Way of Greater Cincinnati (2016–2017) and the PNC Trust Organization of Cincinnati, Ohio (2018–2020).

Figures

Fig. 1.
Fig. 1.
Key driver diagram.
Fig. 2.
Fig. 2.
Number of monthly referrals to high-quality early childhood programs (January 2016–December 2020). Monthly annotated I-chart depicting the number of basic and facilitated referrals to high-quality early childhood programs. Shading depicts the dime period of the population enrollment focus (Spring 2018 to June 2019).
Fig. 3.
Fig. 3.
Percent of children referred who were confirmed to be enrolled (May 2018–December 2020). Drill-down focus on actual enrollment from facilitated referrals during population-level focus (Spring 2018–June 2019) and afterward (sustainability). Monthly (n = 10) annotated statistical control chart (P-chart) depicting the percentage of facilitated referrals confirmed as enrolled in early childhood programming. Shading represents the period of population focus.
Fig. 4.
Fig. 4.
Pareto chart of type of document missing from enrollment package (optimization of efficiency phase: July–October 2018).
See this image and copyright information in PMC

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