How Wisconsin is Implementing Bright Futures - NEW STORY!
Adaptation: The Children's Medical Group (CMG), the primary care division of Children's Hospital of Wisconsin in Milwaukee, uses Bright Futures Guidelines to improve services to all children and families. CMG comprises 26 clinics that are owned by the health system, which has more than 130 providers serving southeastern Wisconsin. As part of the CMG quality infrastructure, the Preventive Services Core Team (composed of clinic managers, pediatricians, nurses, and administrative support staff) was chartered to oversee the implementation of the recommendations in Bright Futures Guidelines. The Core Team analyzes the guidelines, identifies challenges to implementation, and develops solutions to ensure that all children receive high-quality health services.
Implementation: In 2017, a priority of the CMG Preventive Services Core Team focused on developmental screening. At the time, claims data were the only source of information on completion rates for developmental screening. The available data showed that screening rates were close to 50%. To raise the completion rate, the core team used input from clinics to develop a workflow that supported developmental screening. The team then addressed barriers identified in the workflow. One identified barrier was the lack of an efficient documentation tool in the electronic medical record that would allow providers to easily review results during future encounters. The team created an efficient flow sheet in the electronic medical record that would support the workflow and collect data for future use. With a simple click, reassuring answers were recorded. Progress notes were created to allow the data to be pulled in automatically. The results were also recorded in each patient's summary page allowing for easy chart review.
The following graphic demonstrates the rate of improvement in documentation of screening results from April 2017 to October 2018:
This encounter-based measure captures data on children who attended well-child visits rather than on all patients being served.
Quality Improvement: The CMG Preventive Services Core Team continues to work on ensuring that all children receive accurate and timely developmental screenings. Previous successful efforts have focused on ensuring that children receive well-child visits, but these efforts have not captured the entire population of children who are patients at CMG. Therefore, once the process has demonstrated success with the current population, CMG will extend it to all patients it serves.
In addition, the Core Team is using the data to identify trends in screening results. Noting that the 9-month screen produced much fewer reassuring results (69%) than other age ranges (80%‒85%) raised concern among staff and the Core Team. A deeper dive into the data determined that there were false positives in the gross motor domain while all other domains followed trends of other age ranges. Additional analysis will examine how factors related to high-risk populations such as mother's level of education impact screening results. To address some concerns raised in the data analysis, CMG is participating in a Milwaukee-area coalition of early care and education providers to focus on risk factors associated with health outcomes for young children. All CMG staff members receive training in health literacy to support diversity awareness and ensure equitable access to information about screening in culturally and linguistically appropriate ways.
Finally, when developmental concerns arise during screening, CMG supports follow-up and treatment through partnership with Milwaukee County Birth to Three leadership. Simple adjustments to the flow of information have been made within the process to ensure early intervention providers have the information they need from the developmental screening. CMG and Birth to Three continue to work together to ensure parental consent for information sharing. The referral and tracking system in CMG clinics helps CMG staff contact families within a month after a visit and ensures referral services are initiated and follow-up is being completed.