Affiliation:
1. Departments of Pediatrics,
2. Biomedical Informatics, and
3. Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee
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 13 801 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.
Publisher
American Academy of Pediatrics (AAP)
Subject
Pediatrics, Perinatology and Child Health
Reference27 articles.
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/Early-Periodic-Screening-Diagnosis-and-Treatment.html. Accessed January 17, 2012
2. 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
3. EPSDT: Medicaid’s critical but controversial benefits program for children.;Peters;NHPF Issue Brief,2006
4. Early and periodic screening, diagnosis, and treatment and infant health outcomes in Medicaid-insured infants in South Carolina.;Pittard;J Pediatr,2007
5. Effectiveness of compliance with pediatric preventive care guidelines among Medicaid beneficiaries.;Hakim;Pediatrics,2001
Cited by
5 articles.
订阅此论文施引文献
订阅此论文施引文献，注册后可以免费订阅5篇论文的施引文献，订阅后可以查看论文全部施引文献