Practice-tailored facilitation to improve pediatric preventive care delivery: a randomized trial.
Pediatrics
; 133(6): e1664-75, 2014 Jun.
Article
in En
| MEDLINE
| ID: mdl-24799539
ABSTRACT
OBJECTIVE:
Evolving primary care models require methods to help practices achieve quality standards. This study assessed the effectiveness of a Practice-Tailored Facilitation Intervention for improving delivery of 3 pediatric preventive services.METHODS:
In this cluster-randomized trial, a practice facilitator implemented practice-tailored rapid-cycle feedback/change strategies for improving obesity screening/counseling, lead screening, and dental fluoride varnish application. Thirty practices were randomized to Early or Late Intervention, and outcomes assessed for 16 419 well-child visits. A multidisciplinary team characterized facilitation processes by using comparative case study methods.RESULTS:
Baseline performance was as follows for Obesity 3.5% successful performance in Early and 6.3% in Late practices, P = .74; Lead 62.2% and 77.8% success, respectively, P = .11; and Fluoride <0.1% success for all practices. Four months after randomization, performance rose in Early practices, to 82.8% for Obesity, 86.3% for Lead, and 89.1% for Fluoride, all P < .001 for improvement compared with Late practices' control time. During the full 6-month intervention, care improved versus baseline in all practices, for Obesity for Early practices to 86.5%, and for Late practices 88.9%; for Lead for Early practices to 87.5% and Late practices 94.5%; and for Fluoride, for Early practices to 78.9% and Late practices 81.9%, all P < .001 compared with baseline. Improvements were sustained 2 months after intervention. Successful facilitation involved multidisciplinary support, rapid-cycle problem solving feedback, and ongoing relationship-building, allowing individualizing facilitation approach and intensity based on 3 levels of practice need.CONCLUSIONS:
Practice-tailored Facilitation Intervention can lead to substantial, simultaneous, and sustained improvements in 3 domains, and holds promise as a broad-based method to advance pediatric preventive care.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Pediatrics
/
Preventive Health Services
/
Primary Health Care
/
Mass Screening
/
Delivery of Health Care
/
Quality Improvement
Type of study:
Clinical_trials
/
Diagnostic_studies
/
Guideline
/
Prognostic_studies
/
Screening_studies
Aspects:
Determinantes_sociais_saude
Limits:
Child
/
Child, preschool
/
Humans
/
Infant
Language:
En
Journal:
Pediatrics
Year:
2014
Document type:
Article