title: Narrowing Care Gaps for Early Language Delay: A Quality Improvement Study.
abstract: OBJECTIVE
  Poverty is a risk factor for both language delay and failure to access appropriate therapies. The objective of this study was to increase the percentage of children 0 to 3 years old referred from an urban primary care center who attended an initial appointment with speech pathology or audiology within 60 days from 40% to 60%.
  
  
  METHODS
  The Model for Improvement was used to develop and test the intervention, which addressed potential logistical barriers faced by low-income families. Adherence was plotted on run charts in time series to assess overall improvement, and subgroups were analyzed to identify reduction in disparities.
  
  
  RESULTS
  Median referral adherence improved from 40% to 60%. Families from lower income neighborhoods had lower preintervention adherence; these differences were eliminated postintervention.
  
  
  CONCLUSIONS
  System-level changes improved access to evaluation and treatment for low-income children with language delay and narrowed the gap in access between families in lower versus higher income neighborhoods.
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA courtneym.brown@cchmc.org.
authors.forename: Courtney M
authors.initials: CM
authors.lastname: Brown
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Beck
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Wendy
authors.initials: W
authors.lastname: Steuerwald
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Alexander
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Zeina M
authors.initials: ZM
authors.lastname: Samaan
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kahn
authors.affiliation: Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
authors.forename: Mona
authors.initials: M
authors.lastname: Mansour
mesh_terms: D001298:Audiology / Q000706:statistics & numerical data; D002662:Child Health Services; D002675:Child, Preschool; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007805:Language Development Disorders / Q000175:diagnosis / Q000628:therapy*; D008297:Male; D011203:Poverty / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000379:methods / Q000706:statistics & numerical data; D058996:Quality Improvement; D012017:Referral and Consultation / Q000706:statistics & numerical data; D013066:Speech-Language Pathology; D014505:Urban Population / Q000706:statistics & numerical data
keywords: achievement gap; developmental screening; health disparities; language delay; primary care; quality improvement; referral adherence