title: Using quality improvement to promote implementation and increase well child visits in home visiting.
abstract: A key goal of home visiting is to connect children with medical homes through anticipatory guidance regarding recommended well child care (WCC). Substantial barriers to WCC among low socioeconomic families can limit achievement of this outcome. Quality improvement strategies have been widely adopted in healthcare but only recently implemented in home visiting to achieve program outcomes. The objective of this initiative was to increase the percentage of infants enrolled in home visiting who completed at least 3 recommended WCC visits in the first 6 months of life within a large, multi-model program comprised of 11 sites. A series of 33 quality improvement cycles were conducted at 3 sites involving 18 home visitors and 139 families with infants in the target age range. These were deployed sequentially, and changes within and across sites were monitored using trend charts over time. Adopted strategies were then implemented program-wide. Initiatives focused on staff training in WCC recommendations, data collection processes, monthly family tracking reports, and enhanced communication with primary care offices. Data were shared in iterative sessions to identify methods for improving adherence. Wide baseline variability across sites was observed, with the percentage of infants with recommended care ranging from 35% to 83%. Over the project timeline, the percentage of infants receiving at least 3 WCC visits in the first 6 months increased from 58% to 86%. Quality improvement within home visiting can be used to improve WCC adherence and provides an example of maximizing implementation of home visiting interventions.
authors.affiliation: Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
authors.forename: Neera K
authors.initials: NK
authors.lastname: Goyal
authors.affiliation: Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
authors.forename: Robert T
authors.initials: RT
authors.lastname: Ammerman
authors.affiliation: James M. Anderson Center for Health Systems Excellence at the Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Massie
authors.affiliation: United Way of Greater Cincinnati, 2400 Burnet Avenue, Cincinnati, OH 45229, USA.
authors.forename: Margaret
authors.initials: M
authors.lastname: Clark
authors.affiliation: Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
authors.forename: Judith B
authors.initials: JB
authors.lastname: Van Ginkel
mesh_terms: D002662:Child Health Services / Q000592:standards*; D006284:Health Plan Implementation / Q000458:organization & administration / Q000592:standards; D006792:House Calls; D006801:Humans; D007223:Infant; D007629:Kentucky; D009820:Ohio; D016487:Parenting; D010290:Parents / Q000193:education; D058996:Quality Improvement
keywords: Home visiting; Primary care; Quality improvement; Well child care