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Improving Child Development Screening: Implications for Professional Practice and Patient Equity. J Prim Care Community Health 2022;13:21501319211062676



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Pubmed Central ID




Scopus ID

2-s2.0-85122409778 (requires institutional sign-in at Scopus site)   7 Citations


INTRODUCTION AND OBJECTIVES: A pediatric group with 25 clinics and 150 providers used multifaceted approaches to implement workflow processes and an electronic health record (EHR) flowsheet to improve child developmental screening. The key outcome was developmental screening done for every patient during 3 periods between ages 8 and 36 months. Identification of developmental concerns was the secondary study outcome. Screening rates and referrals were hypothesized to be optimized for children regardless of demographic backgrounds.

METHODS: During preventive visits, developmental screens targeted patients in age groups 8 to 12, 13 to 24, and 25 to 36 months. EHRs were analyzed for screening documentation, results, and referrals by patient demographics. Fifteen pediatric professionals were interviewed about their qualitative experiences. Quality improvement interventions included appointing clinic champions, training staff about the screening process and responsibilities, using a standardized tool, employing plan-do-study-act cycles, posting EHR prompts, providing financial incentives, and monitoring screening rates using control charts.

RESULTS: Within 25 months, screening rates improved from 60% to >95% within the 3 preventive visit age groups for a total of more than 30 000 children. Professionals valued the team process improvements. Children enrolled in Medicaid, black children, and those living in lower income zip codes had lower screening rates than privately insured, white children, and those living in higher income areas. Ages and Stages Questionnaire 3rd edition results were significantly different by gender, race/ethnicity, insurance, and income categories across all groups. Referral rates varied by race/ethnicity and zip code of residence.

CONCLUSIONS: This project resulted in an effective and efficient process to improve child developmental screening that was valued by pediatric professionals. Analyses of patient demographics revealed disparities in services for the most vulnerable families. Ongoing quality improvement, health services research, and advocacy offer hope to improve health equity.

Author List

Meurer J, Rohloff R, Rein L, Kanter I, Kotagiri N, Gundacker C, Tarima S


Constance Gundacker MD Interim Chief, Assistant Professor in the Pediatrics department at Medical College of Wisconsin
John R. Meurer MD, MBA Institute Director, Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Lisa E. Rein Biostatistician III in the Institute for Health and Equity department at Medical College of Wisconsin
Sergey S. Tarima PhD Associate Professor in the Institute for Health and Equity department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Child Development
Child, Preschool
Health Services Research
Mass Screening
Referral and Consultation
Surveys and Questionnaires
United States