Practice-tailored facilitation to improve pediatric preventive care delivery: a randomized trial

• Published in: Pediatrics (Evanston) Vol. 133; no. 6; p. e1664
• Main Authors: Meropol, Sharon B, Schiltz, Nicholas K, Sattar, Abdus, Stange, Kurt C, Nevar, Ann H, Davey, Christina, Ferretti, Gerald A, Howell, Diana E, Strosaker, Robyn, Vavrek, Pamela, Bader, Samantha, Ruhe, Mary C, Cuttler, Leona
• Format: Journal Article
• Language: English
• Published: United States 01.06.2014
• Subjects: Child; Child, Preschool; Counseling - standards; Delivery of Health Care - standards; Dental Caries - diagnosis; Dental Caries - prevention & control; Feedback; Fluorides, Topical - administration & dosage; Humans; Infant; Lead Poisoning - diagnosis; Lead Poisoning - prevention & control; Mass Screening - standards; Obesity - diagnosis; Obesity - prevention & control; Pediatrics - standards; Preventive Health Services - standards; Primary Health Care - standards; Quality Improvement - standards; dental caries; lead poisoning; quality improvement; obesity; child
• ISSN: 1098-4275
• DOI: 10.1542/peds.2013-1578

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. 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. 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. 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.