A quality improvement program in pediatric practices to increase tailored injury prevention counseling and assess self-reported changes made by families

• Published in: Injury epidemiology Vol. 5; no. Suppl 1; pp. 17 - 70
• Main Authors: Gittelman, Michael A, Carle, Adam C, Denny, Sarah, Anzeljc, Samantha, Arnold, Melissa Wervey
• Format: Journal Article
• Language: English
• Published: England Springer Nature B.V 10-04-2018; Springer International Publishing; BMC
• Subjects: Behavior change; Behavior modification; Counseling; Families & family life; Injury prevention; Pediatric office visit; Pediatrics; Quality control; Quality improvement; Behavior change; Quality improvement; Injury prevention; Pediatric office visit
• ISSN: 2197-1714; 2197-1714
• DOI: 10.1186/s40621-018-0145-z

Many pediatric providers struggle to screen families for the majority of age-appropriate injury risks and educate them when appropriate. Standardized tools have helped physicians provide effective, more purposeful counseling. In this study, pediatricians utilized a standardized, injury prevention screening tool to increase targeted discussions and families were re-screened at subsequent visits to determine changes in their behavior.
Pediatric practices, recruited from the Ohio Chapter, American Academy of Pediatrics database, self-selected to participate in a quality improvement program. Two screening tools, for children birth-4 month and 6-12 month, with corresponding talking points, were to be implemented into every well child visit. During the 7-month collaborative, screening results and pediatrician counseling for reported unsafe behaviors were calculated. Patients who completed a screening tool at subsequent visits were followed up at a later visit to determine self-reported behavior changes. We examined statistically significant differences in frequencies using the X
test. Providers received maintenance of certification IV credit for participation.
Seven practices (39 providers) participated. By the second month, participating providers discussed 75% of all inappropriate responses for birth-4 month screenings and 87% for 6-12 months. Of the 386 families who received specific counseling and had a follow-up visit, 65% (n = 94/144) of birth-4 month and 65% (n = 59/91) of 6-12 month families made at least one behavior change. The X
test showed that families who received counseling versus those that did not were significantly more likely to change inappropriate behaviors (p < 0.05). Overall, of all the risks identified, 45% (136) of birth-4 month and 42% (91) of 6-12 month behaviors reportedly changed after a practitioner addressed the topic area.
Participation in a quality improvement program within pediatric offices can increase screening for injury risks and encourage tailored injury prevention discussions during an office encounter. As a result, significantly more families reported to practice safer behaviors at later visits.