Adaptation: North Dakota’s Medicaid program has adopted the Bright Futures/American Academy of Pediatrics (AAP) Periodicity Schedule. The state’s Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program is closely aligned with the Bright Futures/AAP Periodicity Schedule, although there are differences with respect to the timing and frequency of well-child visits. Specifically, North Dakota’s EPSDT program does not recommend visits prenatally, at 30 months, or at 21 years of age, all of which are recommended by the Bright Futures/AAP Periodicity Schedule.
In 2012, Health Tracks (Medicaid), a free preventive health program for Medicaid-eligible children from birth to age 21, decided it would no longer update the well-child care forms used across the state. Instead, providers were directed to use the Bright Futures forms and tools, making North Dakota one of the first states to replace Medicaid forms with Bright Futures resources. The transition was met with a few challenges, including incompatibility with electronic health record systems. Physicians and nurses across the state have adapted the forms to create their own forms using the Bright Futures Guidelines as a model.
Implementation: In 2014, North Dakota selected 5 of the 11 pediatric preventive care measures to focus on: child and adolescent access to primary care providers, well-child visits for children ages 3 to 6, adolescent well-child visits, adolescent immunization status, and preventive dental visits. All the measures are closely aligned to the Bright Futures Preventive Services Quality Improvement Measures. According to a recent Centers for Medicare & Medicaid Services report, North Dakota’s quality performance rates were higher than the national average for primary care visits by adolescents and adolescent immunizations but lower than the national average for primary care visits by children at 25 months to 11 years, preventive visits for children ages 3 to 6, and preventive dental visits. As a result, pediatric preventive care improvement projects are being implemented in well-child care, childhood immunizations, and oral health.
Training: Many well-child visits are performed by public health nurses. State public health officials became interested in training public health nurses who travel to rural areas to perform checkups and immunizations.
State leaders contacted the Bright Futures National Center to ask about training for child health professionals and medical home staff, with the goal of incorporating the Bright Futures Guidelines into North Dakota’s EPSDT program. In November 2012, public health nurses and physicians participated in a full-day training on Bright Futures and preventive services, which was recorded and posted on the state health department Web site.