title: Improving developmental screening documentation and referral completion.
abstract: OBJECTIVE
  Screening, early identification, and referral improves outcomes for young children at risk for developmental delays. Effective developmental screening processes should include efforts to ensure referral completion and documentation of evaluation results and service eligibility in the child's medical record. Our objectives were to improve provider documentation of actions taken after an abnormal developmental screening result and increase Early Intervention (State Part C) referrals.
  
  
  METHODS
  Various strategies including an electronic medical record template, monthly clinical informatics reporting, and a phone follow-up after an abnormal screening result were implemented to enhance provider documentation of screening results and improve referral actions and outcomes.
  
  
  RESULTS
  Of the children eligible for screening (n = 3023), 2610 (86%) were screened, with 382 (15%) scoring in the abnormal range. With phone follow-up, 50% of the abnormal screenings were referred to community resources, including 43% to Early Intervention (EI), in contrast to 20% community referrals and 13% EI referrals with the screening template only (P < .0001). Provider documentation of EI outcomes increased when screening templates and follow-up calls were implemented together (31%) as compared with using the screening template alone (15%).
  
  
  CONCLUSIONS
  Enhanced documentation of developmental screening efforts using screening templates and clinical informatics reporting in combination with phone follow-up after an abnormal screening result improved developmental screening outcomes, including referral rates, completed evaluations, and provider documentation of EI services. Such strategies can be effectively used in pediatric primary care settings to improve screening processes and ensure that young children access appropriate services.
authors.affiliation: Departments of Psychiatry, and Pediatrics, University of Colorado, School of Medicine, Aurora, Colorado; Children's Outcomes Research, and ayelet.talmi@ucdenver.edu.
authors.forename: Ayelet
authors.initials: A
authors.lastname: Talmi
authors.affiliation: Pediatrics, University of Colorado, School of Medicine, Aurora, Colorado; Children's Outcomes Research, and.
authors.forename: Maya
authors.initials: M
authors.lastname: Bunik
authors.affiliation: Departments of Psychiatry, and.
authors.forename: Ryan
authors.initials: R
authors.lastname: Asherin
authors.affiliation: Clinical Informatics, Children's Hospital Colorado, Aurora, Colorado; and.
authors.forename: Michael
authors.initials: M
authors.lastname: Rannie
authors.affiliation: Pediatrics, University of Colorado, School of Medicine, Aurora, Colorado;
authors.forename: Tyler
authors.initials: T
authors.lastname: Watlington
authors.affiliation: Preventative Medicine and Biometrics, Colorado Health Outcomes Program, University of Colorado Denver, Aurora, Colorado.
authors.forename: Brenda
authors.initials: B
authors.lastname: Beaty
authors.affiliation: Pediatrics, University of Colorado, School of Medicine, Aurora, Colorado;
authors.forename: Stephen
authors.initials: S
authors.lastname: Berman
mesh_terms: D002675:Child, Preschool; D002658:Developmental Disabilities / Q000175:diagnosis* / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006776:Hospitals, Pediatric / Q000592:standards / Q000639:trends; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D015997:Neonatal Screening / Q000592:standards / Q000639:trends*; D058996:Quality Improvement / Q000592:standards / Q000639:trends*; D012017:Referral and Consultation / Q000592:standards / Q000639:trends*; D012307:Risk Factors
keywords: developmental assessment; early intervention; pediatric; primary health care; quality improvement