title: A pilot quality improvement program to increase pediatrician injury anticipatory guidance.
abstract: BACKGROUND
  Because of a lack of time and training, many pediatricians often address few, if any, injury topics during well-child visits. The project goal was to increase the injury anticipatory guidance topics covered by pediatricians during well-child visits by offering screening tools and focused talking points through a quality improvement learning collaborative.
  
  
  METHODS
  Screening tools were developed and pretested. Pediatric practices, recruited through the Ohio American Academy of Pediatrics, were taught quality improvement theory and injury prevention strategies at a learning session. Pediatricians worked to implement screening tools and talking points into every well-child visit for children 1 year or younger. Monthly, providers reviewed five random charts for each of the six well-child visits for screening tool use and age-appropriate injury prevention discussion. Providers received maintenance of Certification IV credit.
  
  
  RESULTS
  Sixteen pediatricians (six practices) participated. Screening tool use increased from 0% to 97.2% in just 3 months of the program. For each well-child care visit, injury prevention discussion increased by 89.5% for newborn visit, 88.1% for 2-month, 93.6% for 4-month, 94.0% for 6-month, 88.1% for 9-month, and 90.3% for 12-month-old babies. During the quality improvement program, discussion points for all children 1 year or younger increased for all age-appropriate topics. The greatest percent increase in discussions occurred with water safety (from 10.8% to 95.7%, n = 231), play safety (from 17.9% to 93.5%, n = 154), and supervision safety (from 20.8% to 94.4%, n = 251). More commonly addressed topics also had a significant increase in discussions: sleep safety (from 48% to 93.9%, n = 262), choking (from 44.7% to 95.4%, n = 172), and car safety (from 41.2% to 80.1%, n = 332).
  
  
  CONCLUSIONS
  Participation in a maintenance of Certification IV quality improvement program within pediatric offices can increase screening and discussion of injury anticipatory guidance.
  
  
  METHODS
  Therapeutic/care management study, level IV.
authors.affiliation: From the Division of Emergency Medicine (M.A.G., M.F.), Cincinnati Children's Hospital Medical Center, Cincinnati; Division of Emergency Medicine (S.D.), Nationwide Children's Hospital, Columbus; and Ohio Chapter of the American Academy of Pediatrics (S.A., M.W.A.), Worthington, Ohio.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Gittelman
authors.forename: Sarah
authors.initials: S
authors.lastname: Denny
authors.forename: Samantha
authors.initials: S
authors.lastname: Anzeljc
authors.forename: Mike
authors.initials: M
authors.lastname: FitzGerald
authors.forename: Melissa Wervey
authors.initials: MW
authors.lastname: Arnold
mesh_terms: D002568:Certification; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening / Q000592:standards*; D010372:Pediatrics / Q000193:education* / Q000592:standards*; D010865:Pilot Projects; D058996:Quality Improvement; D014947:Wounds and Injuries / Q000175:diagnosis*