P2D186: Increasing Comprehensive Pediatric Screening Through Healthysteps Program Implementation

Purpose/Objectives: HealthySteps is an evidence-based national model that integrates a child development specialist into primary care. All patients ages 0-3 years who are seen for well-child care receive comprehensive screening as part of Tier 1-Universal services. HealthySteps launched at two federally qualified health centers in a marginalized urban neighborhood in July of 2021. Noticing subpar screening rates in the first 3 months of implementation, Plan-Do-Study-Act cycles were conducted to reach the HealthySteps fidelity target of 75% of children seen for well-child care having been screened for developmental concerns, social-emotional/behavioral concerns, postpartum depression, autism and social determinants of health (i.e., family needs).

Design/Methods: The screening workflow involves (1) front desk staff distributing the age-appropriate Survey of Well-being of Young Children (SWYC) form to caregivers, (2) medical assistants collecting the form and scoring it; (3) providers reviewing results, documenting results in the EMR, discussing any concerns with caregivers, and referring families to HealthySteps if appropriate. In the Plan phase, automated reports were built to extract screening data from the EMR, which was calculated as the number of patients with results [of each SWYC subscale] recorded / number of patients with billing code for well-child care in the SWYC age range (i.e., 2-48 months). After establishing a baseline screening rate, the Do phase involved several rounds of quality improvement interventions aimed at steps 1 and 3 of the screening workflow: weekly reports of scheduled appointments and which age SWYC form to administer were sent to front desk staff every Monday, documentation training was provided to providers at monthly staff meetings by HealthySteps program manager or pediatrician champion, and program manager conducted medical scribe training about SWYC documentation. During the Study phase, screening rates for each clinic were reviewed monthly to evaluate the outcomes of implemented interventions and inform the selection of next clinic-specific quality improvement interventions for the Act phase.

Results: In the first 3 months of HealthySteps implementation at the larger clinic (#1), the percentage of children screened for development was 45% and increased to 76% a year later (August 2022). At the clinic with fewer pediatric patients (#2), the developmental screening rate increased from 10% to 78%. See Figures for rates of documentation of SWYC results for each subscale.

Conclusion/Discussion: The addition of the HealthySteps program, and the resources it included (i.e., staff to respond to elevated screening results, administrative support to track data and implement QI interventions, accountability to funders) supported a significant improvement in comprehensive screening of pediatric patients (ages 0-3) in these two federally qualified health centers. The PDSA cycles resulted in noteworthy progress towards fidelity to the HealthySteps model and improvement in the healthcare quality metric of developmental screening in the first 3 years of life.