Impact of healthy steps on developmental referral rates.

Abstract

BACKGROUND AND OBJECTIVES: Diagnosis and treatment of pediatric mental, physical, and behavioral issues are essential for optimal growth and development. Our family medicine residency program implemented a change in our pediatric curriculum by incorporating aspects of Healthy Steps into well-child visits 1 day a week. This study was done to determine the impact on developmental referral rates after incorporating Healthy Steps. METHODS: We did a retrospective medical records review at a rural California family medicine residency clinic on children through 5 years of age receiving well-child care. We collected developmental referrals as documented in the chart and in a referral log for 1 year before the curriculum change and 3 years after implementation. This retrospective case-control study included a pre-intervention group (Pre) and two post-intervention groups, usual care control (UC) and Healthy Steps intervention (HS). The three groups were compared using Fisher's exact tests. RESULTS: Developmental referrals assessed by chart review were 0% (0/154) in Pre, 0.6% (1/159) in UC, and 5.4% (4/74) in HS groups. When assessed by referral logs, developmental referral rates were 1.2% (10/864) in Pre, 1.1% (14/1,251) in UC, and 9.9% (14/141) in HS groups. For both sources, the HS group had significantly higher referral rates than the other groups. There was no statistical difference in referrals between the Pre and UC groups. CONCLUSIONS: After incorporating aspects of Healthy Steps into our curriculum, developmental referrals rose significantly in the intervention group compared to pre-intervention. Referral rates did not change in the non-intervention control group.