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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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| Published in: | Pediatrics (Evanston) 2014-06, Vol.133 (6), p.e1664-e1675 |
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| container_title | Pediatrics (Evanston) |
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| creator | 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 |
| description | 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: |
| doi_str_mv | 10.1542/peds.2013-1578 |
| format | article |
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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: <0.1% success for all practices. Four months after randomization, performance rose in Early practices, to 82.8% for Obesity, 86.3% for Lead, and 89.1% for Fluoride, all P < .001 for improvement compared with Late practices' control time. During the full 6-month intervention, care improved versus baseline in all practices, for Obesity for Early practices to 86.5%, and for Late practices 88.9%; for Lead for Early practices to 87.5% and Late practices 94.5%; and for Fluoride, for Early practices to 78.9% and Late practices 81.9%, all P < .001 compared with baseline. Improvements were sustained 2 months after intervention. Successful facilitation involved multidisciplinary support, rapid-cycle problem solving feedback, and ongoing relationship-building, allowing individualizing facilitation approach and intensity based on 3 levels of practice need.
Practice-tailored Facilitation Intervention can lead to substantial, simultaneous, and sustained improvements in 3 domains, and holds promise as a broad-based method to advance pediatric preventive care.</description><identifier>ISSN: 0031-4005</identifier><identifier>EISSN: 1098-4275</identifier><identifier>DOI: 10.1542/peds.2013-1578</identifier><identifier>PMID: 24799539</identifier><identifier>CODEN: PEDIAU</identifier><language>eng</language><publisher>United States: American Academy of Pediatrics</publisher><subject>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</subject><ispartof>Pediatrics (Evanston), 2014-06, Vol.133 (6), p.e1664-e1675</ispartof><rights>Copyright © 2014 by the American Academy of Pediatrics.</rights><rights>Copyright American Academy of Pediatrics Jun 2014</rights><rights>Copyright © 2014 by the American Academy of Pediatrics 2014</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c456t-9f0f9c3d3ff86082e77e2b83158c69f2be8c3a3d2339778b36bf11d8341fad023</citedby><cites>FETCH-LOGICAL-c456t-9f0f9c3d3ff86082e77e2b83158c69f2be8c3a3d2339778b36bf11d8341fad023</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24799539$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Meropol, Sharon B</creatorcontrib><creatorcontrib>Schiltz, Nicholas K</creatorcontrib><creatorcontrib>Sattar, Abdus</creatorcontrib><creatorcontrib>Stange, Kurt C</creatorcontrib><creatorcontrib>Nevar, Ann H</creatorcontrib><creatorcontrib>Davey, Christina</creatorcontrib><creatorcontrib>Ferretti, Gerald A</creatorcontrib><creatorcontrib>Howell, Diana E</creatorcontrib><creatorcontrib>Strosaker, Robyn</creatorcontrib><creatorcontrib>Vavrek, Pamela</creatorcontrib><creatorcontrib>Bader, Samantha</creatorcontrib><creatorcontrib>Ruhe, Mary C</creatorcontrib><creatorcontrib>Cuttler, Leona</creatorcontrib><title>Practice-tailored facilitation to improve pediatric preventive care delivery: a randomized trial</title><title>Pediatrics (Evanston)</title><addtitle>Pediatrics</addtitle><description>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: <0.1% success for all practices. Four months after randomization, performance rose in Early practices, to 82.8% for Obesity, 86.3% for Lead, and 89.1% for Fluoride, all P < .001 for improvement compared with Late practices' control time. During the full 6-month intervention, care improved versus baseline in all practices, for Obesity for Early practices to 86.5%, and for Late practices 88.9%; for Lead for Early practices to 87.5% and Late practices 94.5%; and for Fluoride, for Early practices to 78.9% and Late practices 81.9%, all P < .001 compared with baseline. Improvements were sustained 2 months after intervention. Successful facilitation involved multidisciplinary support, rapid-cycle problem solving feedback, and ongoing relationship-building, allowing individualizing facilitation approach and intensity based on 3 levels of practice need.
Practice-tailored Facilitation Intervention can lead to substantial, simultaneous, and sustained improvements in 3 domains, and holds promise as a broad-based method to advance pediatric preventive care.</description><subject>Child</subject><subject>Child, Preschool</subject><subject>Clinical trials</subject><subject>Comparative analysis</subject><subject>Counseling - standards</subject><subject>Delivery of Health Care - standards</subject><subject>Dental Caries - diagnosis</subject><subject>Dental Caries - prevention & control</subject><subject>Effectiveness studies</subject><subject>Feedback</subject><subject>Fluorides, Topical - administration & dosage</subject><subject>Health aspects</subject><subject>Health care delivery</subject><subject>Humans</subject><subject>Infant</subject><subject>Intervention</subject><subject>Lead Poisoning - diagnosis</subject><subject>Lead Poisoning - prevention & control</subject><subject>Mass Screening - standards</subject><subject>Medical care</subject><subject>Medical care (Private)</subject><subject>Obesity</subject><subject>Obesity - diagnosis</subject><subject>Obesity - prevention & control</subject><subject>Pediatrics</subject><subject>Pediatrics - standards</subject><subject>Preventive Health Services - standards</subject><subject>Preventive medicine</subject><subject>Primary care</subject><subject>Primary Health Care - standards</subject><subject>Quality Improvement - standards</subject><subject>Quality management</subject><issn>0031-4005</issn><issn>1098-4275</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><recordid>eNpVkc-P1CAYhonRuOPq1aNp4rkj8EGhHkw2E38lm6wHPSOFj5FNp1TKTFz_emlm3egJAg8v75eHkJeMbpkU_M2MftlyyqBlUulHZMNor1vBlXxMNpQCawWl8oI8W5ZbSqmQij8lF1yovpfQb8j3L9m6Eh22xcYxZfRNsC6OsdgS09SU1MTDnNMJm_pVtCVH18wZTziVWA-dzdh4HOs-371tbJPt5NMh_q5BlbXjc_Ik2HHBF_frJfn24f3X3af2-ubj593VdeuE7ErbBxp6Bx5C0B3VHJVCPmhgUruuD3xA7cCC5wC9UnqAbgiMeQ2CBesph0vy7pw7H4cDelf7ZTuaOceDzXcm2Wj-v5niD7NPJyMoSKl1DXh9H5DTzyMuxdymY55qZ8MkyK7rgEKl2jO1tyOaOLk0FfxVXBpH3KOpI-1uzBUoJTTlfOW3Z97ltCwZw0MjRs1q0KwGzWrQrAbrg1f_zvGA_1UGfwDnKpj2</recordid><startdate>201406</startdate><enddate>201406</enddate><creator>Meropol, Sharon B</creator><creator>Schiltz, Nicholas K</creator><creator>Sattar, Abdus</creator><creator>Stange, Kurt C</creator><creator>Nevar, Ann H</creator><creator>Davey, Christina</creator><creator>Ferretti, Gerald A</creator><creator>Howell, Diana E</creator><creator>Strosaker, Robyn</creator><creator>Vavrek, Pamela</creator><creator>Bader, Samantha</creator><creator>Ruhe, Mary C</creator><creator>Cuttler, Leona</creator><general>American Academy of Pediatrics</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TS</scope><scope>7U9</scope><scope>H94</scope><scope>K9.</scope><scope>M7N</scope><scope>NAPCQ</scope><scope>U9A</scope><scope>5PM</scope></search><sort><creationdate>201406</creationdate><title>Practice-tailored facilitation to improve pediatric preventive care delivery: a randomized trial</title><author>Meropol, Sharon B ; 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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: <0.1% success for all practices. Four months after randomization, performance rose in Early practices, to 82.8% for Obesity, 86.3% for Lead, and 89.1% for Fluoride, all P < .001 for improvement compared with Late practices' control time. During the full 6-month intervention, care improved versus baseline in all practices, for Obesity for Early practices to 86.5%, and for Late practices 88.9%; for Lead for Early practices to 87.5% and Late practices 94.5%; and for Fluoride, for Early practices to 78.9% and Late practices 81.9%, all P < .001 compared with baseline. Improvements were sustained 2 months after intervention. Successful facilitation involved multidisciplinary support, rapid-cycle problem solving feedback, and ongoing relationship-building, allowing individualizing facilitation approach and intensity based on 3 levels of practice need.
Practice-tailored Facilitation Intervention can lead to substantial, simultaneous, and sustained improvements in 3 domains, and holds promise as a broad-based method to advance pediatric preventive care.</abstract><cop>United States</cop><pub>American Academy of Pediatrics</pub><pmid>24799539</pmid><doi>10.1542/peds.2013-1578</doi><oa>free_for_read</oa></addata></record> |
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| ispartof | Pediatrics (Evanston), 2014-06, Vol.133 (6), p.e1664-e1675 |
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| source | EZB Electronic Journals Library |
| 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 |
| title | Practice-tailored facilitation to improve pediatric preventive care delivery: a randomized trial |
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