225 - Improving On-time Developmental and Autism Screening at Brookdale Family Care Center - Quality Improvement Project in Progress

Publication Number: 4222.225

Monika Beltre, Brookdale University Hospital and Medical center, brooklyn, NY, United States; Hanna Ankudovich, One Brooklyn Health/Brookdale Hospital and Medical Center, Brooklyn, NY, United States; Srivarsha Ala, Brookdale University Hospital Medical Center, Brooklyn, NY, United States; Fernanda Kupferman, one Brooklyn health at Brookdale, Brooklyn, NY, United States; Shailendra K. Yadav, One Brooklyn Health/ Brookdale University Hospital and Medical Center, Brooklyn, NY, United States; Ogochukwu A. Okonkwo, One Brooklyn Health - Brookdale Hospital, Brooklyn, NY, United States; Phan Thanh Le, Brookdale hospital and medical center, Brooklyn, NY, United States; Krithika Murthy, Brookdale Hospital Medical Center, Brooklyn, NY, United States; Hayder G. Ferman, brookdale, new york, NY, United States; Quynh Nguyen, One Brooklyn Health - Brookdale University Medical Center, New York, NY, United States; Magali Molina, brookdale medical, brooklyn, NY, United States; Ji Hyun Park, Brookdale University Hospital and Medical Center, Brooklyn, NY, United States; Ahmed Faragallah, One Brooklyn Health, Brooklyn, NY, United States; Hari Dharanee Thomas Paulraj, Brookldale hospital medical centre, Brooklyn Newyork, NY, United States; Allison Lieber, OBH - Brookdale Hospital, Brooklyn, NJ, United States; Hetal Tangal, OBH, Brooklyn, NY, United States; Kusum Viswanathan, OBH, Brooklyn, NY, United States

Background: The prevalence of developmental disabilities is estimated to be 17% among children between the ages of 3-17 years living in the United States (1). This fact supports the need for an objective screening tool to detect developmental delays in pediatric populations. According to AAP, Ages and Stages Questionnaire, Third Edition (ASQ-3) and Survey of Well- being of Young Children (SWYC), as well as, Modified Checklist for Autism in Toddlers Revised (M-CHAT-R); have been identified as standardized tools for screening for developmental delay and autism, at 9,18, 30 and at 18 and 24 months of age respectively (2).

Objective: To increase on-time developmental and autism screening rates to 80% at 9, 18, 24 and 30 month well-child visits at the five Brookdale Family Care Centers (BFCC) pediatric practices.

Design/Methods: The study was conducted at five community-based pediatric practices in a Brooklyn teaching hospital. Utilizing Plan-Do-Study-Act (PDSA) model, seven cycles were conducted starting February 2021. Ages and Stages Questionnaire (ASQ-3), Survey of Well-being of Young Children (SWYC), and Modified Checklist for Autism in Toddlers, Revised (MCHAT-R) are used for screening. Interventions included staff education, workflow improvement, resident champions, electronic reminders, billable screenings, and HealthySteps (HS) integration enhancing support for developmental and autism screening workflows.

Results: Initial screening rates were 16% (developmental) and 21% (autism). Incremental improvements followed each PDSA cycle intervention, with on-time screening achieving 80%, noticeably in sites with established HealthySteps specialist. The SWYC, recently implemented as a pilot at one of our BFCC's to provide an alternative screening tool to ASQ-3, showed significant improvement in workflow, with current cycles showing increased developmental screening rate at this site.

Conclusion(s): Each cycle intervention led to sustained increases in on-time screening rates towards achieving our 80% goal. Ongoing efforts focus on maintaining gains, adding SWYC as an established alternative for developmental screening at all sites, integrating HealthyStep to the remaining BFCC's and enhancing follow-up for children with abnormal results.

Figure 1. Avg. Screening Rate per PDSA Cycle


Figure 2. Screening Rate per BFCC