Promoting Pediatric Preventive Visits Through Quality Improvement Initiatives in the Primary Care Setting

Objective To evaluate whether quality improvement (QI) capacity-building in affiliated primary care practices could increase well care visit uptake. Study design Partners For Kids (PFK) is an accountable care organization caring for pediatric Medicaid beneficiaries in Ohio. PFK QI specialists recruited practices to develop QI projects around increasing well care visit rates (proportion of eligible children with well care visits during calendar year) for children aged 3-6 years and adolescents. The QI specialists supported practice teams in implementing interventions and collecting data through monthly or bimonthly practice visits. Results Ten practices, serving more than 26 000 children, participated in QI projects for a median of 8.5 months (IQR 5.3-17.6). Well care visit rates in the QI-engaged practices significantly improved from 2016 to 2018 (P < .001 for both age groups). Over time, well care visit rates for 3- to 6-year-old children increased by 11.8% (95% CI 5.4%-18.2%) in QI-engaged practices, compared with 4.1% (95% CI 0.1%-7.4%) in non-engaged practices (P = .233). For adolescents, well care visit rates increased 14.3% (95% CI -2.6% to 31.2%) compared with 5.4% (95% CI 1.8%-9.0%) in QI-engaged vs non-engaged practices over the same period (P = .215). Although not statistically significant, QI-engaged practices had greater magnitudes of rate increases for both age groups. Conclusions Through practice facilitation, PFK helped a diverse group of community practices substantially improve preventive visit uptake over time. QI programs in primary care can reach patients early to promote preventive services that potentially avoid costly downstream care.

Automated summary

This study demonstrated that quality improvement capacity-building in primary care practices led to significant improvements in well care visit rates for children aged 3-6 years and adolescents. While the difference was not statistically significant, practices engaged in quality improvement projects showed greater increases in well care visit rates compared to non-engaged practices. Through practice facilitation, preventive visit uptake was substantially improved over time, emphasizing the importance of early intervention in promoting preventive services in primary care settings.