Improving delivery of preventative care services using population management strategies.

Abstract

Consistent and timely delivery of comprehensive preventative care services is a challenge, particularly in underserved patient populations. Previous quality improvement (QI) research has focused on the development of bundled measures of preventative services delivery, but these bundles have not been studied on a population level. We aimed to improve preventative care service delivery on a clinic population level through the use of a bundled measure that includes immunisations, lead screening and use of screening tools among underserved patients under 2 years old. A QI study was conducted at a community-based academic primary care clinic. A population-level bundled measure was adapted from an existing tool. We used plan-do-study-act cycles to optimise results and tracked bundle outcome rates using a p-type statistical process control chart. Interventions included (1) staff education on measure components, (2) introduction of exam room-based phlebotomy to address lead screening completion rates and (3) population management strategies, including development of a patient registry and use of reminders and visit tracking to increase attendance at well-child visits. The percent of bundle completion by 14 months of age increased from a baseline of 58%-77% following implementation of the QI initiatives. A mean shift was identified after the population manager began proactive targeted outreach for the 12-month visit. Targeted systems for outreach aimed at bringing patients into the clinic and patient-centred strategies for visit completion are effective at ensuring timely delivery of comprehensive preventative care to an underserved paediatric population.