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Making Structured Developmental Assessment a Reality

Making Structured Developmental Assessment a Reality. QuIIN Conference Call Series June 6, 2007 Amy Driscoll, MD, FAAP Oxford Pediatrics and Adolescents, Oxford, Ohio. Disclaimer.

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Making Structured Developmental Assessment a Reality

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  1. Making Structured Developmental Assessment a Reality QuIIN Conference Call Series June 6, 2007 Amy Driscoll, MD, FAAP Oxford Pediatrics and Adolescents, Oxford, Ohio

  2. Disclaimer • I have no relevant financial relationships with the manufacturers(s) of any commercial products(s) and/or provider of commercial services discussed in this CME activity. • I do not intend to discuss an unapproved/investigative use of a commercial product/device in my presentation.

  3. Oxford Pediatrics and Adolescents • Rural, private practice in a college town • Oxford, Ohio – one hour away from Cincinnati and Dayton, two hours from Indianapolis • 5 physicians, 2 nurse practitioners, and support staff • Brookville, Indiana satellite office • Electronic medical records (EMR) • Using structured developmental assessment since 2004

  4. Why use structured developmental assessment? • Recommended by AAP • Too much to do in a 15 minute well visit • Identify problems at an earlier age • Validate parents concerns or provide reassurance • Standard way for all providers in a group to assess development

  5. Choosing a screening tool • Parent questionnaire • Ages and Stages Questionnaire (ASQ) • Parents Evaluation of Developmental Status (PEDS) • Child Development Inventory (CDI) • Pediatric Symptom Checklist (PSC) • Direct Elicitation • Bayley Infant Neurodevelopmental Screener (BINS) • Brigance • Denver II

  6. Choosing a screening tool • Time to use tool, and score • Given at home vs. office • Cost of tool • One time fee or ongoing fees • Can copies be made • What ages are screened • How sensitive/specific is each tool • How does tool fit in with office flow ???

  7. PDSA cycle - Plan • Objective – Use screening tool for well visits under 5 years. • Questions – Which visits will tool be used? When will parents fill it out? Who will score tool and when? Where will info be kept in the chart or EMR? How will patients and providers feel about using the tool? • Predictions – Parents will enjoy doing the activities, providers will have a better way to assess development.

  8. PDSA - Plan • Plan for change • 2 providers will try using tool first • Use at 6, 12, and 18 month well visits • A front desk staff member will mail questionnaire 2 weeks in advance • Parents will do activities with child at home • Plan for data collection • Monthly chart review • Amount of time for visits before and after

  9. PDSA - Do • ASQ was mailed out 2 weeks before appointments • Parents gave form to M.A. when called back for appointment • M.A. scored ASQ while preparing patient for well visit • Provider reviewed ASQ results with parent during visit, made referrals as needed

  10. PDSA - Study • Well accepted by parents • Providers felt tool was valuable • Children with problems were identified and referred. • Use of tool did not prolong visit time unless parent filled out tool in office.

  11. PDSA - Act • Continue plan • Involve all other providers in the office • Expand to all well visits between 4 months to 5 years.

  12. Problems and Solutions • Parents forgot to bring back questionnaire • Mail in later, or fill out another • Questionnaire not received in mail • Box of toys in office for kids to try activities • Parents don’t want to fill (another) one out • Provider does assessment “the old way” • Decreased how often tool is used

  13. What to do if there is a delay • Verify that delay exists • Did child try activities? • Was child in a good mood? • ASQ activity sheets • Referrals • Early intervention, speech therapy • Referral list kept in each room

  14. What to do if there is not a delay, but parents are concerned • Acknowledge parental concerns • Remember sensitivity of tool • Repeat developmental screen soon, or use another tool • Consider need for referral

  15. Coding • 96110 – developmental screening with report • Usually good reimbursement • Parental complaints about charge • Letter to parents mailed with questionnaire

  16. Keys to Success • Ask for ideas from everyone the change will affect. • Make certain all staff are aware of changes being implemented, how it is being done, who is responsible for which tasks, and what the benefits are. • Be willing to change plans if it’s not working. • Tell everyone when it is working and share patient feedback.

  17. References • www.dbpeds.org • Bright Futures Systems Toolkit, 2004. • The ASQ User’s Guide, Second Edition, 1999.

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