title: Development of a bundle measure for preventive service delivery to infants in primary care.
abstract: OBJECTIVE
  In the United States, paediatric patients receive only 41% of indicated preventive services. Past improvement efforts have not bundled preventive services to measure the reliability with which infants' physical, developmental and emotional needs are all addressed. We aimed to create a comprehensive bundle measure that reflects reliable delivery of preventive services during primary care visits, as well as overall preventive service status of a population of patients served by three primary care centres.
  
  
  METHODS
  Data were collected from electronic health records for cohorts of infants < 14 months old with at least one visit to one of three primary care centres. Immunizations, lead screening, developmental screening and screening for biopsychosocial risk factors (gestational age, parental depression, food insecurity) were chosen by local expert consensus for inclusion in the preventive services bundle measure. Monthly measures of preventive service status at 14 months of age were constructed. A visit-level bundle measure of preventive service delivery was also created. To obtain a baseline for improvement work, bundle completion rates were calculated for infants born in May 2011. Visit-level performance was measured for visits from July to August 2012.
  
  
  RESULTS
  Among 278 patients born in May 2011, 22% of patients received the entire bundle of preventive services by 14 months of age. On a visit level, patients received all indicated services at 58% of visits.
  
  
  CONCLUSIONS
  A novel bundle measure can be used to characterize delivery of preventive services and drive improvement at both an individual visit level and a population level.
authors: Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: Courtney M
authors: CM
authors: Brown
authors: Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: Zeina M
authors: ZM
authors: Samaan
authors: Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: John F
authors: JF
authors: Morehous
authors: Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: Alison A
authors: AA
authors: Perkins
authors: Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: Robert S
authors: RS
authors: Kahn
authors: Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors: Mona E
authors: ME
authors: Mansour
mesh_terms: D002662:Child Health Services / Q000458:organization & administration*; D005260:Female; D006302:Health Services Research; D006801:Humans; D007223:Infant; D008297:Male; D009820:Ohio; D064872:Patient Care Bundles; D018802:Patient-Centered Care; D011314:Preventive Health Services / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D014481:United States
keywords: bundle measure; electronic health record; health care quality; infant health; preventive services; well child care