title: Improving Adolescent Preventive Care in an Urban Pediatric Clinic: Capturing Missed Opportunities.
abstract: OBJECTIVE
  To increase the proportion of adolescents with Medicaid who receive preventive care services in an urban pediatric clinic.
  
  
  METHODS
  A quality improvement intervention was implemented at an urban pediatric primary care clinic between November 2013 and October 2014. The intervention systematically "flipped" acute visits into well-care visits for patients ages 12-21 years, when overdue. The primary process measure was the percentage of acute visits expanded to include well-care components out of total eligible opportunities. The primary outcome measure was adolescent well-care (AWC) completion in 2014 versus 2013 and 2012.
  
  
  RESULTS
  Among 857 adolescents with Medicaid, 124 additional AWC visits were completed by October 2014 compared to 2013 and 71 additional visits compared to 2012. The gap to achieving Healthcare Effectiveness Data and Information Set neutral zone targets for AWC was reduced by 59% compared to 2013 and by 54% compared to 2012. The mean proportion of eligible acute opportunities "flipped" monthly increased from 17% (range: 10%-21%) during the initial 3 months of implementation to 30% (range: 5%-50%) in the last 3 months.
  
  
  CONCLUSIONS
  Systematically flipping acute visits into well visits resulted in reaching Healthcare Effectiveness Data and Information Set quality targets for AWC, which had not previously been accomplished by this clinic. Incorporating staff and provider feedback strengthened intervention fidelity and buy-in despite time constraints in a busy, urban setting.
authors.affiliation: Johns Hopkins Community Physicians, Baltimore, Maryland; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Health Policy & Management, Johns Hopkins School of Public Health, Baltimore, Maryland. Electronic address: tkumra1@jhmi.edu.
authors.forename: Tina
authors.initials: T
authors.lastname: Kumra
authors.affiliation: Department of Pediatrics, Columbia University Medical Center, New York, New York.
authors.forename: Shweta
authors.initials: S
authors.lastname: Antani
authors.affiliation: Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Population Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
authors.forename: Sara B
authors.initials: SB
authors.lastname: Johnson
authors.affiliation: Department of Health Policy & Management, Johns Hopkins School of Public Health, Baltimore, Maryland; Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland.
authors.forename: Sallie J
authors.initials: SJ
authors.lastname: Weaver
mesh_terms: D000293:Adolescent; D000067697:Adolescent Health; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008484:Medicaid; D010372:Pediatrics; D011314:Preventive Health Services / Q000592:standards*; D011320:Primary Health Care / Q000592:standards; D058996:Quality Improvement; D014481:United States; D014505:Urban Population; D055815:Young Adult
keywords: Adolescent health; Clinical preventive care; Community health; Quality improvement