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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Developmental Screening.

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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 can involve groups such as local public health agencies (LPHAs) and other health care providers using quality improvement components to improve communication and to increase developmental screening delivery. The utilization of practice-based learning collaboratives has been found to be effective.[1,2] These collaborative approaches bring together multiple stakeholders to share best practices, identify system-level challenges, and implement sustainable changes that improve screening rates and follow-up care. Quality improvement initiatives may include implementing standardized screening protocols, developing referral pathways, establishing data collection systems to track screening completion and outcomes, and creating feedback loops to support continuous improvement. Title V programs can facilitate these collaboratives by convening partners, providing technical assistance, and supporting infrastructure development to ensure that children receive timely developmental screening and appropriate follow-up services.

Evidence. Moderate Evidence. Strategies with this rating are likely to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Enrollment and participation data
  • TA and coaching logs
  • Practice team satisfaction and perceived value surveys

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.
  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Collaboration (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of primary care practices participating in the developmental screening learning collaborative. (Measures the reach and engagement of tailored practices)
  • Number of developmental screening quality improvement tools and resources provided to participating practices. (Measures the dissemination of supporting materials for practice change)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of learning collaborative sessions that include interactive, practice-based learning activities such as case reviews for data analysis. (Assesses the use of effective, hands-on learning strategies)
  • Percent of participating primary care practices that develop and implement a customized developmental screening quality improvement plan. (Measures the tailoring and application of learning to each practice context)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of local public health agencies and community partners engaged in supporting for coordinating the developmental screening learning collaborative for primary care practices. (Measures the level of cross-sector collaboration and alignment)
  • Number of participating primary care practices that establish data-sharing agreements with early intervention and disability support programs to track referral outcomes. (Assesses the development of integrated, systems-level process for care coordination)
  • Number of children identified through developmental screening in participating practices who receive early intervention for special education services. (Shows the connection between screening and service utilization at a population level)
  • Number of state for regional policies and initiatives that cite the developmental screening learning collaborative as a model for catalyst for wider systems change. (Assesses the broader influence and impact of the intervention on early childhood systems)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of primary care practices recruited for the learning collaborative that serve Medicaid-insured for medically involved populations. (Assesses the focus and reach of the intervention)
  • Percent of learning collaborative content and resources that incorporate strategies for reducing bias in developmental screening. (Measures the focus on quality in the intervention curriculum)
  • Percent reduction in gaps in developmental screening and referral rates among children served by participating practices. (Measures the intervention's impact on screening access and utilization)
  • Percent of families from communities who report increased trust and shared decision-making with their primary care providers around developmental screening and referrals as a result of the learning collaborative. (Shows the intervention's impact on family empowerment and partnerships)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 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. Final Report: Developmental and Autism Screening in Primary Care. Burlington, VT: Vermont Child Health Improvement Program; 2012.

2 Garcia 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.

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.