P2D185: Improving Developmental Screening (Ages and questionnaire-3) and Autism Screening (M-CHAT-R) at Brookdale Family Care Center ( BFCC) - A Quality Improvement Project in Progress

Purpose/Objectives: This quality improvement project is intended to increase 80% of the rates of developmental screening with the ASQ-3 and autism screening with the M-CHAT-R at routine well-child visits at BFCCs in one year.

Design/Methods: This study was conducted at five community-based ambulatory pediatric practices in an urban community teaching hospital in Brooklyn, New York. Children presenting to the clinic for a well-child visit at 9, 18, 24, and 30 months were included in this study. The project was started in February 2021 and it is still in progress. Plan-Do-Study-Act (PDSA) methodology was implemented which included providing staff education, assigning champions to promote awareness, introducing SmartForm in Electronic Medical Records (EMR), and transforming developmental screenings as billable encounters. The percentage of well-child visits in which developmental screening was completed appropriately was determined from the monthly EMR (EPIC) reports and manual chart review.

Results: Before implementing this project, the cumulative baseline rate of developmental screening with ASQ-3 and Autism screening with MCHAT-R in our five clinics were 16% and 21% respectively. The first PDSA cycle targeted staff education and implementing appropriate workflows to ensure screenings were provided to caregivers during their visits. This cycle improved rates of ASQ-3 to 32% and MCHAT-R to 63%. A second cycle focused on the correct identification of children requiring screening and providing the correct forms at check-in. This was accomplished with enhancements to our EHR which improved rates to 40% and 67%. In our third cycle, we assigned pediatric resident champions to provide on-site support and monitor screening rates at each clinic. We noticed rates of 36% and 57% which were attributed to a COVID variant reducing time in well visits. Our final cycle identified the opportunity to bill for the screening tools. With this final intervention, we observed ASQ-3 was given on time 60% of the time and M-Chat-R was administered 84% of the time. Implementing these PDSA cycles aided not only the improvement of Developmental and Autism screening but improved documentation of ASQ-3 and MCHAT-R screening tools, improved physician and health staff compliance, and improved rates of physicians’ billing.

Conclusion/Discussion: By embedding screening tools into our EMR, assigning clinic champions, identifying patients to be screened in the morning huddle, and modifying the screening encounters to billable encounters in our data analysis processes, we observed steady progress towards our goal of 80% on-time developmental screening tools at key well-child visits.