Improving Developmental Screening in a Resident Group Continuity Clinic Practice

Both the Denver Developmental Screening Test (Denver) and the Modified Checklist for Autism in Toddlers (M-CHAT) are recommended to screen for developmental delay or abnormalities. In our Resident Group Practice in an urban academic center, there was inconsistency in the timing of screening and in the follow-up of abnormal screens. In an initial review of our practice, less than 50% of patients at the 9 or 24 month visit had a Denver performed and only 63% of patients had a M-CHAT at 18 months. The goal of our quality improvement (QI) project was to increase performance of screening tests and to improve timeliness of developmental interventions. Specifically, during one academic year, our aim was to screen 95% of children presenting for well-child care at the 9, 18, and 24 month visits. Also, 95% of patients with abnormal tests will have appropriate documentation in the chart and a plan for follow-up. Each PGY-2 resident participated in this team-oriented QI project during a 3 week primary care block. Our interventions centered on modification of the electronic medical record (EMR) and provision of education to the residents in the practice about appropriate developmental screening practices. After each intervention, approximately 5-10 charts from each target age group were reviewed with a focus on our aim measures. After resident education, administration and documentation of developmental screening tests increased but did not reach our goal. The next cycle consisted of implementation of changes to the EMR, including prompts to complete the exam at certain visits. Review of charts after this cycle revealed that 100% of patients had documentation of screening. However, among children with an abnormal screen, only 79% had an appropriate referral or plan for follow-up. In conclusion, increasing residents' awareness of developmental screening recommendations was not sufficient. Permanent modification of the EMR did achieve results that satisfied one of our aim measures. In the future, continued work needs to be done to ensure that patients with abnormal results are managed appropriately.