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Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest. NPM 6: Developmental Screening

MCHbest Logo toddler and doctor playing with their noses

Strategy. Quality Improvement Programs in Health Care Settings

Approach. Support practice-based learning collaborative for primary care practices.

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Overview. Systems level approaches involve groups such as local public health agencies (LPHAs) and other health care providers with quality improvement components to increase developmental screening delivery. The utilization of practice-based learning collaboratives has been found to be effective.1,2

Evidence. Moderate Evidence. Quality improvement in health care settings appears to be effective. This strategy could include a statewide learning collaborative for pediatric practices. Programs based on this strategy are likely to work. This strategy has been tested more than once and results trend positive overall. Access the peer-reviewed evidence through the MCH Digital Library. (Read more about understanding evidence ratings).

Target Audience. Health care practices.

Outcome. Increased developmental screenings performed with a validated screening tool (>80% sensitivity and specificity). The literature shows a dramatic increase during well-child visits. For detailed outcomes related to each study supporting this strategy, click on the peer-reviewed evidence link above and read the "Intervention Results" for each study.

Examples from the Field. Access descriptions of current ESMs through the MCH Digital Library. You can use these ESMs to see how other Title V agencies are addressing the NPM.

In New Mexico, seven pediatric primary care practices participated in the New Mexico Developmental Screening Initiative in a year-long quality improvement project. The goal was to implement standardized developmental screening tools. Using a collaborative learning approach and the Model for Improvement to promote AAP best practice. Overall, the use of standardized developmental screening tools increased from 27% at baseline to 92% at the end of the project.3

The Role of Title V. Title V agencies can support quality improvement programs in health care setting through a number of approaches:

For additional suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies.

Sample ESMs. Using the approach “Support practice-based learning collaborative for primary care practices,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework:

QUADRANT 1:
Measuring Quantity of Effort
("What/how much did we do?")

  • Number of practices participating in QI process around developmental screening practices.
  • Number of Local Public Health Agencies (LPHAs), community and/or health care partners that have implemented Assuring Better Child Health and Development (ABCD) quality standards that support early childhood screening, referral and treatment services for developmental needs.

QUADRANT 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of practices participating in QI process around developmental screening practices.
  • Percent of LPHAs, community and/or health care partners that have implemented quality standards that support early childhood screening, referral and treatment services for developmental needs.

QUADRANT 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Number of practices participating in QI process around developmental screening practices with improved screening rates.
  • Number of LPHAs, community and/or health care partners that have implemented quality standards and have given referrals and treatment if needed after screening.

QUADRANT 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of LPHAs, community and/or health care partners that have implemented quality standards and have given referrals and treatment if needed after screening.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


References:

1 Barry S, Paul K, Aakre K, Drake-Buhr S, Willis R.Ā Final Report: Developmental and Autism Screening in Primary Care.Ā Burlington, VT: Vermont Child Health Improvement Program; 2012.

2Garcia S, Brown E, Strobino D, & Minokovitz C. National Performance Measure 6 Developmental Screening Evidence Review. Strengthen the Evidence for Maternal and Child Health Programs. 2018. Women's and Children's Health Policy Center, John Hopkins University, Baltimore, MD.

3Malik F, Booker JM, Brown S, McClain C, & McGrath J. Improving developmenta screening among pediatricians in New Mexico: Findings from the developmental screening initiative. Clinical Pediatrics. 2014: 53(6):531-538.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.