Screenings during Well-Child Visits in Primary Care: A Quality Improvement Study

J Am Board Fam Med. Jul-Aug 2018;31(4):558-569. doi: 10.3122/jabfm.2018.04.170222.


Background: Early Periodic Screening, Diagnosis, and Treatment visits are designed to address physical, mental, and developmental health of children enrolled in Medicaid.

Methods: We conducted a mixed methods intervention by using a quality improvement theory. We assessed preintervention and postintervention screening rates of development, anemia, lead, oral health, vision and hearing, interventions for improvement, and barriers for the well-child visits at an academic family medicine clinic. For quantitative analysis, we assessed the preintervention baseline for 183 children and postintervention outcome for 151 children. For qualitative analysis, we used group interviews and key informant interviews to develop interventions in the preintervention stage and to explore potential barriers for further improvement in the postintervention stage.

Results: Interventions based on baseline results included user-friendly materials, checklists, posters, education, and order sets. After the intervention, there were significant statistical improvements (P < .05) for the anemia test ordered rate, serum lead test ordered rate, oral health screening and referral rates, and ordered and confirmed test rates for both vision and hearing. Despite these improvements, 3 qualitative findings indicated barriers for further improvement, including difficulties in venipuncture, medical assistant aversion to vision screening, and poor fit of equipment for hearing assessment. The procedures prompted further continuous quality improvement activities using fingerstick hemoglobin testing, a child-friendly vision screener, and manual audiometer with headphones.

Conclusions: The trial findings demonstrated potential benefits of improving screenings in an office-based intervention by using a quality improvement process. Postintervention qualitative findings illustrate additional factors that could be addressed for further improvements.

Keywords: Child; Family Medicine; Physical Examination; Quality Improvement.

Publication types

  • Observational Study

MeSH terms

  • Child Development
  • Child Health*
  • Child, Preschool
  • Humans
  • Infant
  • Infant, Newborn
  • Mass Screening / organization & administration*
  • Mass Screening / statistics & numerical data
  • Medicaid
  • Patient Education as Topic
  • Physical Examination
  • Primary Health Care / methods
  • Primary Health Care / organization & administration*
  • Qualitative Research
  • Quality Improvement*
  • Referral and Consultation / statistics & numerical data
  • United States