title: Results of a primary care-based quality improvement project to optimize chart-based vision screening for preschool age children.
abstract: To design chart-based vision screening for preschool-aged children.
  
  
  
  Our program consisted of educational sessions for providers as well as hands-on training for practice staff. We evaluated the intervention through pre- and post-intervention review of medical records.
  
  
  
  Completion of full vision screening (distance visual acuity in each eye plus stereovision beginning at 3 years of age, as recommended at the time of the project) at well-child visits improved for 5-year-olds (45.0% to 58.2%; risk difference +13.2% [95% CI, 1.7-24.7]) and 4-year-olds (39.3% to 51.4%; risk difference +12.0% [95% CI, 0.7-23.4]) but declined somewhat among 3-year-olds (23.1% to 14.3%; risk difference, -8.8% [95% CI, -17.7 to 0.0]). Risk factors for not being fully screened included being 3 years old (risk ratio of 4.1 compared to 5-year-olds) and being a patient of a small practice (risk ratio of 1.9 compared to large practices).
  
  
  
  This quality improvement project showed that screening for visual acuity and stereovision among preschool-aged children using chart-based techniques is difficult to accomplish and unlikely to be consistently successful, especially among 3-year-olds.
authors.affiliation: Pediatric Physicians' Organization at Children's, Brookline, Massachusetts.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Modest
authors.affiliation: Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Suzanne C
authors.initials: SC
authors.lastname: Johnston
authors.affiliation: Prevent Blindness, Boston, Massachusetts.
authors.forename: Katherine M
authors.initials: KM
authors.lastname: Majzoub
authors.affiliation: New England College of Optometry, Boston, Massachusetts.
authors.forename: Bruce
authors.initials: B
authors.lastname: Moore
authors.affiliation: Pediatric Physicians' Organization at Children's, Brookline, Massachusetts.
authors.forename: Emily K
authors.initials: EK
authors.lastname: Trudell
authors.affiliation: Department of Ophthalmology, Boston University Medical Center, Boston, Massachusetts.
authors.forename: Jean E
authors.initials: JE
authors.lastname: Ramsey
authors.affiliation: Pediatric Physicians' Organization at Children's, Brookline, Massachusetts; Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts. Electronic address: louis.vernacchio@childrens.harvard.edu.
authors.forename: Louis
authors.initials: L
authors.lastname: Vernacchio
mesh_terms: D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D011320:Primary Health Care; D058996:Quality Improvement; D012307:Risk Factors; D015351:Vision Screening; D014792:Visual Acuity