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

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 impleme...

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Bibliographic Details
Published in:Pediatrics (Evanston) 2014-06, Vol.133 (6), p.e1664-e1675
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: Article
Language:English
Subjects:
Child
Child, Preschool
Clinical trials
Comparative analysis
Counseling - standards
Delivery of Health Care - standards
Dental Caries - diagnosis
Dental Caries - prevention & control
Effectiveness studies
Feedback
Fluorides, Topical - administration & dosage
Health aspects
Health care delivery
Humans
Infant
Intervention
Lead Poisoning - diagnosis
Lead Poisoning - prevention & control
Mass Screening - standards
Medical care
Medical care (Private)
Obesity
Obesity - diagnosis
Obesity - prevention & control
Pediatrics
Pediatrics - standards
Preventive Health Services - standards
Preventive medicine
Primary care
Primary Health Care - standards
Quality Improvement - standards
Quality management
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Summary: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:
ISSN:0031-4005
1098-4275
DOI:10.1542/peds.2013-1578