Assisting primary care practices in using office systems to promote early childhood development.
OBJECTIVE
The aim of this study was to use family-centered measures to estimate the effect of a collaborative quality improvement program designed to help practices implement systems to promote early childhood development services.


METHODS
A cohort study was conducted in pediatric and family practices in Vermont and North Carolina. Eighteen collaborative education practices and 17 comparison practices participated in a 12-month program to assist practices in implementing improved systems to provide anticipatory guidance and parental education. The main outcome measures were change over time in parent-reported measures of whether children received each of 4 aspects of recommended care, documentation of developmental and psychosocial screening, and practice-reported care delivery systems.


RESULTS
The number of care delivery systems increased from a mean of 12.9 to 19.4 of 27 in collaborative practices and remained the same in comparison practices (P=.0002). The proportion of children with documented developmental and psychosocial screening among intervention practices increased from 78% to 88% (P<.001) and from 22% to 29% (P=.002), respectively. Compared with control practices, there was a trend toward improvement in the proportion of parents who reported receiving at least 3 of 4 areas of care.


CONCLUSIONS
The learning collaborative was associated with an increase in the number of practice-based systems and tools designed to elicit and address parents' concerns about their child's behavior and development and a modest improvement in parent-reported measures of the quality of care.
Margolis
Peter A
PA
Center for Health Care Quality, Division of Health Policy and Clinical Effectiveness, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45299, USA. peter.margolis@cchmc.org
McLearn
Kathryn Taaffe
KT
Earls
Marian F
MF
Duncan
Paula
P
Rexroad
Annette
A
Reuland
Colleen Peck
CP
Fuller
Sandra
S
Paul
Kimberly
K
Neelon
Brian
B
Bristol
Tara E
TE
Schoettker
Pamela J
PJ
D002657:Child Development; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007223:Infant; D009657:North Carolina; D009816:Office Automation; D010043:Outcome and Process Assessment, Health Care; D010290:Parents / Q000193:education*; D010372:Pediatrics / Q000458:organization & administration*; D011314:Preventive Health Services / Q000592:standards*; D011320:Primary Health Care / Q000458:organization & administration*; D011785:Quality Assurance, Health Care; D012044:Regression Analysis; D014707:Vermont