Bronx ongoing pediatric screening (BOPS) in the medical home: A demonstration of rapid-cycle learning for quality improvement

Research Objective: To evaluate the impact of a learning collaborative model on ability of primary care practices to demonstrate decreased time in achieving quality improvement outcomes.

Background: Bronx Ongoing Pediatric Screening in the Medical Home (BOPS) is incorporates evidence-based medical home screening strategies across the pediatric lifespan in 13 pediatric, family medicine, and school health practices in Bronx, NY. BOPS combines a modified learning collaborative, using multidisciplinary onsite teams, coupled with real-time clinical data feedback to practitioners, quality improvement coaching and a pay-for-quality monetary incentive. The four-year project targets four screening domains: 1) newborn screening for genetic, metabolic and infectious diseases, 2) infant and toddler screening for developmental, behavioral and social/emotional disorders, 3) school age and adolescent mental health screening, and 4) screening of sexually active adolescents for sexually transmitted infections.

Results: On average, for the first two domains addressed – newborn screening and adolescent sexual activity assessment - teams as a collective took six months to show improvement in the measures for these domains. Data reports were distributed in November 2011, the first domain crossover transition occurred in January 2012, and improvement in both the new and in the original focal area was significant. With the recent initiation of the third and fourth domains, all sites have gone from a baseline of 0% to at least 30% for screening in the new domains within the first full month of the launch of those domains in November 2012.

Newborn screening increased from 19% (SD=±0.32) to 86%(SD=±0.20) by 75 days of life. Documentation in the electronic medical record of adolescent sexual history increased from 60 %( SD=±0.25) to 88 %( SD=±0.08) at annual well child visits, HIV screening for sexually active adolescents increased from 52% (SD=±0.23) to 65%(SD=±0.12) and screening for gonorrhea and chlamydia from 62% (SD=±0.25)to 79%(SD=±0.13). Starting in October 2012, routine mental health screening in early childhood through adolescence, screening for developmental concerns at 12 months, 18 months and 24 months increased from a baseline of 0% to 30-35% in the first 6 weeks. Mental health screening for children 4-11 and 12-18 at annual well visits started at 0%, and increased to 75% and 82%, respectively within six weeks. We also measured difference between types of visits in which activities were conducted.

Conclusions: Preliminary evidence from BOPS demonstrates the positive impact of focused quality improvement learning collaboratives on primary care practices conducting increasingly rapid quality improvement initiatives.