title: Implementation of a Preventive Services Bundle in Academic Pediatric Primary Care Centers.
abstract: OBJECTIVE
  Previous studies have documented poor rates of delivery of preventive services, 1 of the core services provided in the primary care medical home setting. We aimed to increase the reliability of delivering a bundle of preventive services to patients 0 to 14 months of age from 58% of patient visits to 95% of visits. The bundle includes administration of routine vaccinations, offering influenza vaccination, completed lead screening, completed developmental screening tool, screening for maternal depression and food insecurity, and documentation of gestational age.
  
  
  METHODS
  The setting was 3 academic pediatric primary care clinics that serve 31,000 patients (>90% Medicaid). Quality improvement methodology was used and key driver diagram was determined. Patient "Ideal Visit Flow" and the Responsible, Accountable, Support, Consulted, and Informed Matrix were developed to drive accountability for components of the ideal flow. Plan, Do, Study, Act cycles were used to develop successful interventions. The percent of patients seen who received all bundle elements for which they were eligible was plotted weekly on a run chart, and statistical process control methods were used to determine a significant change in performance.
  
  
  RESULTS
  The preintervention percentage of patient visits ages 0 to 14 months receiving all preventive service bundle elements was 58%. The postintervention percentage is 92%.
  
  
  CONCLUSIONS
  Innovative redesign led to improvement in percentage of patients age 0 to 14 months who received the entire preventive services bundle. Key elements for success were multidisciplinary site-specific teams, redesigned visit flow, effective communication, and resources for data and project management.
authors.affiliation: Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio zeina.samaan@cchmc.org.
authors.forename: Zeina Marcho
authors.initials: ZM
authors.lastname: Samaan
authors.affiliation: Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Courtney M
authors.initials: CM
authors.lastname: Brown
authors.affiliation: Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: John
authors.initials: J
authors.lastname: Morehous
authors.affiliation: Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Alison A
authors.initials: AA
authors.lastname: Perkins
authors.affiliation: Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Kahn
authors.affiliation: Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
authors.forename: Mona E
authors.initials: ME
authors.lastname: Mansour
mesh_terms: D002662:Child Health Services / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D009820:Ohio; D011314:Preventive Health Services / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D058996:Quality Improvement