title: Practice-tailored facilitation to improve pediatric preventive care delivery: a randomized trial.
abstract: OBJECTIVE
  Evolving primary care models require methods to help practices achieve quality standards. This study assessed the effectiveness of a Practice-Tailored Facilitation Intervention for improving delivery of 3 pediatric preventive services.
  
  
  METHODS
  In this cluster-randomized trial, a practice facilitator implemented practice-tailored rapid-cycle feedback/change strategies for improving obesity screening/counseling, lead screening, and dental fluoride varnish application. Thirty practices were randomized to Early or Late Intervention, and outcomes assessed for 16 419 well-child visits. A multidisciplinary team characterized facilitation processes by using comparative case study methods.
  
  
  RESULTS
  Baseline performance was as follows: for Obesity: 3.5% successful performance in Early and 6.3% in Late practices, P = .74; Lead: 62.2% and 77.8% success, respectively, P = .11; and Fluoride: <0.1% success for all practices. Four months after randomization, performance rose in Early practices, to 82.8% for Obesity, 86.3% for Lead, and 89.1% for Fluoride, all P < .001 for improvement compared with Late practices' control time. During the full 6-month intervention, care improved versus baseline in all practices, for Obesity for Early practices to 86.5%, and for Late practices 88.9%; for Lead for Early practices to 87.5% and Late practices 94.5%; and for Fluoride, for Early practices to 78.9% and Late practices 81.9%, all P < .001 compared with baseline. Improvements were sustained 2 months after intervention. Successful facilitation involved multidisciplinary support, rapid-cycle problem solving feedback, and ongoing relationship-building, allowing individualizing facilitation approach and intensity based on 3 levels of practice need.
  
  
  CONCLUSIONS
  Practice-tailored Facilitation Intervention can lead to substantial, simultaneous, and sustained improvements in 3 domains, and holds promise as a broad-based method to advance pediatric preventive care.
authors.affiliation: Departments of Pediatrics,Epidemiology and Biostatistics,The Center for Child Health and Policy, Rainbow Babies and Children's Hospital, Cleveland, Ohio sharon.meropol@uhhospitals.org.
authors.forename: Sharon B
authors.initials: SB
authors.lastname: Meropol
authors.affiliation: Epidemiology and Biostatistics,The Center for Child Health and Policy, Rainbow Babies and Children's Hospital, Cleveland, Ohio.
authors.forename: Nicholas K
authors.initials: NK
authors.lastname: Schiltz
authors.affiliation: Epidemiology and Biostatistics.
authors.forename: Abdus
authors.initials: A
authors.lastname: Sattar
authors.affiliation: Epidemiology and Biostatistics,Family Medicine and Community Health,Oncology,Sociology.
authors.forename: Kurt C
authors.initials: KC
authors.lastname: Stange
authors.affiliation: The Center for Child Health and Policy, Rainbow Babies and Children's Hospital, Cleveland, Ohio.
authors.forename: Ann H
authors.initials: AH
authors.lastname: Nevar
authors.affiliation: Departments of Pediatrics,The Center for Child Health and Policy, Rainbow Babies and Children's Hospital, Cleveland, Ohio.
authors.forename: Christina
authors.initials: C
authors.lastname: Davey
authors.affiliation: Departments of Pediatrics,Pediatric Dentistry, and.
authors.forename: Gerald A
authors.initials: GA
authors.lastname: Ferretti
authors.affiliation: Departments of Pediatrics,The Center for Child Health and Policy, Rainbow Babies and Children's Hospital, Cleveland, Ohio.
authors.forename: Diana E
authors.initials: DE
authors.lastname: Howell
authors.affiliation: Departments of Pediatrics.
authors.forename: Robyn
authors.initials: R
authors.lastname: Strosaker
authors.affiliation: The Center for Child Health and Policy, Rainbow Babies and Children's Hospital, Cleveland, Ohio.
authors.forename: Pamela
authors.initials: P
authors.lastname: Vavrek
authors.affiliation: The Center for Child Health and Policy, Rainbow Babies and Children's Hospital, Cleveland, Ohio.
authors.forename: Samantha
authors.initials: S
authors.lastname: Bader
authors.affiliation: Family Medicine and Community Health.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Ruhe
authors.affiliation: Departments of Pediatrics,The Center for Child Health and Policy, Rainbow Babies and Children's Hospital, Cleveland, OhioBioethics, Case Western Reserve University, Cleveland, Ohio; and.
authors.forename: Leona
authors.initials: L
authors.lastname: Cuttler
mesh_terms: D002648:Child; D002675:Child, Preschool; D003376:Counseling / Q000592:standards; D003695:Delivery of Health Care / Q000592:standards*; D003731:Dental Caries / Q000175:diagnosis / Q000517:prevention & control; D005246:Feedback; D005460:Fluorides, Topical / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D007855:Lead Poisoning / Q000175:diagnosis / Q000517:prevention & control; D008403:Mass Screening / Q000592:standards*; D009765:Obesity / Q000175:diagnosis / Q000517:prevention & control; D010372:Pediatrics / Q000592:standards*; D011314:Preventive Health Services / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D058996:Quality Improvement / Q000592:standards*
chemical_list: D005460:Fluorides, Topical
keywords: child; dental caries; lead poisoning; obesity; quality improvement