title: Improving delivery of EPSDT well-child care at acute visits in an academic pediatric practice.
abstract: 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 13801 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.
authors.affiliation: Department of Pediatrics, Vanderbilt University School of Medicine, 8236 Doctors' Office Tower, 2200 Children's Way, Nashville, TN 37232, USA. barron.patterson@vanderbilt.edu
authors.forename: Barron L
authors.initials: BL
authors.lastname: Patterson
authors.forename: William M
authors.initials: WM
authors.lastname: Gregg
authors.forename: Cynthia
authors.initials: C
authors.lastname: Biggers
authors.forename: Shari
authors.initials: S
authors.lastname: Barkin
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration / Q000592:standards*; D000208:Acute Disease; D002648:Child; D002662:Child Health Services / Q000458:organization & administration / Q000592:standards*; D002675:Child, Preschool; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D007223:Infant; D008484:Medicaid; D011314:Preventive Health Services / Q000458:organization & administration / Q000592:standards*; D015397:Program Evaluation; D058996:Quality Improvement / Q000458:organization & administration*; D012189:Retrospective Studies; D013714:Tennessee; D014481:United States