79 - Implementation of a Kindergarten Readiness Promotion Bundle in an Academic Primary Care Network

Publication Number: 2075.79

Kitty O'Hare, Duke University School of Medicine, Cary, NC, United States; jane Anne A. O'Dell, Duke Primary Care, Durham, NC, United States; Sara H. Johnson, Duke Primary Care, Durham, NC, United States; Lisbeth Gierman, Duke Health, Pittsboro, NC, United States; Tabitha A. Chandler, Duke University School of Medicine, Apex, NC, United States; Ashley D. Nance, Duke Health, Durham, NC, United States

Background: The Integrated Care for Kids (InCK) model from North Carolina Medicaid specifies a core set of preventive health measures that are crucial for child well-being and for success upon entry into school. Collectively these measures comprise the Kindergarten Readiness Promotion Bundle (KRPB). Across North Carolina, only half of children are assessed as being ready for kindergarten.

Objective: We are a lifespan academic primary care network with over 45 locations in urban, suburban, and rural communities. Practice specialties include General Pediatrics, Internal Medicine-Pediatrics, and Family Medicine. Our patient population reflects a diverse payor mix. In order to optimize the value proposition of the KRPB, we used a payor-blind approach to implement the bundle across our entire population of patients aged 0-5 years.

Design/Methods: We interviewed frontline staff, provider leaders, and operations leaders across the network to understand baseline knowledge of, and attitudes toward, the KRPB. Then we assembled a multidisciplinary improvement team to develop an A3. Using gap analysis, the improvement team identified multiple countermeasures to improve fidelity to available KRPB components. The team also implemented KRPB components that were not previously available in the our network. High-performing practices were paired with lower-performing practices for coaching. Using the electronic health record (EHR), we generated run charts of orders and interventions to monitor progress toward goals.

Results: The intervention impacted >15,000 children in 20 practices across 17 zip codes. Multiple countermeasures were deployed: 1) provider & staff education, 2) access to well child care, 3) EHR enhancements, 4) new behavioral health screenings, 5) new referral pathways, 6) literacy promotion. Run charts show consistent, sustained improvement in KRPB components. There are particular improvements in Fluoride Varnish administration, behavioral health screening and referrals, and literacy promotion. As a next step, we intend to monitor for adherence to KRPB components. We also intend to expand our referral services for parenting supports and for early pre-K services.

Conclusion(s): It is feasible to implement a Kindergarten Readiness Promotion Bundle at scale across a large, diverse primary care network. The KRPB offers a robust base of preventive care services that contribute to lifelong health. It may serve to close gaps in school readiness across a broad population. We intend to maintain the elements of the KRPB in all primary care locations that serve children.

Fluoride Varnish Application
% of Well Child visits with orders for dental fluoride varnish after first tooth eruption

Literacy Promotion
% of Well Child visits for ages 0-5 years who received a Reach Out and Read book

Developmental Screening
% of Well Child visits for ages 2 months-5 years who were screened for development with a standardized tool