Well-Child Visits Improve With Scrutiny

ATLANTA — Delivering optimal well-child care in the office depends on teamwork, teamwork, and more teamwork.

And the best way to determine how well your “medical home team” is working is to look at how you are doing with the help of an outside observer, Dr. Paula Duncan, professor of pediatrics at the University of Vermont, Burlington, said at the annual meeting of the American Academy of Pediatrics.

Dr. Duncan, cochairperson of the Bright Futures Pediatric Implementation Project, outlined some strategies that individual practices can use to improve the preventive and developmental services they offer their young patients and families.

First and foremost, each practice has to put itself under a microscope to see just how it actually functions, she said.

A well-trained outside facilitator can be extremely helpful, she added. Dr. Duncan described a practice that hired an observer to detail exactly how it operated.

“This practice was obviously interested in improvement. They were willing to look at how everyone in the practice—from the receptionist at the front desk, to the nurse-practitioner, to the physicians—interacted with each other and with patients. The observer noted how patients were moved through the office, how work was actually done in this office, and how patients were treated. The results highlighted where improvements could be made and also showed what they were doing that was absolutely right,” she said.

As part of this process of looking inward, the practice also had meetings once a week. In addition to the personnel of the practice and the facilitator, the meetings included a parent. “I love having a parent as part of the team. The partnership between parents and the medical home is very important,” Dr. Duncan said.

It is essential to be able to learn what is on the parent's mind. The logical way to assess this is via questionnaires, but the practice team must be alert to those parents who may have difficulty filling out these questionnaires for one reason or another.

“One way to make sure we are getting this information is to have the nurse, or physician, or both, ask: “What are you concerned about today? Once we learn the parents' concerns, we then have to make sure we address them,” she said. Other strategies include:

▸ Use of reminder systems.

▸ Development of a registry of patients who have special health care needs.

▸ Use of questionnaires at every visit to ask about parental and youths' concerns.

▸ Use of a confidentiality policy for teens.

▸ Use of a list to prompt essential preventive services.

▸ A referral follow-up system.

“The way to make improvements is to get the whole office involved, and to get everybody working together,” she said.

ATLANTA — Delivering optimal well-child care in the office depends on teamwork, teamwork, and more teamwork.

And the best way to determine how well your “medical home team” is working is to look at how you are doing with the help of an outside observer, Dr. Paula Duncan, professor of pediatrics at the University of Vermont, Burlington, said at the annual meeting of the American Academy of Pediatrics.

Dr. Duncan, cochairperson of the Bright Futures Pediatric Implementation Project, outlined some strategies that individual practices can use to improve the preventive and developmental services they offer their young patients and families.

First and foremost, each practice has to put itself under a microscope to see just how it actually functions, she said.

A well-trained outside facilitator can be extremely helpful, she added. Dr. Duncan described a practice that hired an observer to detail exactly how it operated.

“This practice was obviously interested in improvement. They were willing to look at how everyone in the practice—from the receptionist at the front desk, to the nurse-practitioner, to the physicians—interacted with each other and with patients. The observer noted how patients were moved through the office, how work was actually done in this office, and how patients were treated. The results highlighted where improvements could be made and also showed what they were doing that was absolutely right,” she said.

As part of this process of looking inward, the practice also had meetings once a week. In addition to the personnel of the practice and the facilitator, the meetings included a parent. “I love having a parent as part of the team. The partnership between parents and the medical home is very important,” Dr. Duncan said.

It is essential to be able to learn what is on the parent's mind. The logical way to assess this is via questionnaires, but the practice team must be alert to those parents who may have difficulty filling out these questionnaires for one reason or another.

“One way to make sure we are getting this information is to have the nurse, or physician, or both, ask: “What are you concerned about today? Once we learn the parents' concerns, we then have to make sure we address them,” she said. Other strategies include:

▸ Use of reminder systems.

▸ Development of a registry of patients who have special health care needs.

▸ Use of questionnaires at every visit to ask about parental and youths' concerns.

▸ Use of a confidentiality policy for teens.

▸ Use of a list to prompt essential preventive services.

▸ A referral follow-up system.

“The way to make improvements is to get the whole office involved, and to get everybody working together,” she said.

ATLANTA — Delivering optimal well-child care in the office depends on teamwork, teamwork, and more teamwork.

And the best way to determine how well your “medical home team” is working is to look at how you are doing with the help of an outside observer, Dr. Paula Duncan, professor of pediatrics at the University of Vermont, Burlington, said at the annual meeting of the American Academy of Pediatrics.

Dr. Duncan, cochairperson of the Bright Futures Pediatric Implementation Project, outlined some strategies that individual practices can use to improve the preventive and developmental services they offer their young patients and families.

First and foremost, each practice has to put itself under a microscope to see just how it actually functions, she said.

A well-trained outside facilitator can be extremely helpful, she added. Dr. Duncan described a practice that hired an observer to detail exactly how it operated.

“This practice was obviously interested in improvement. They were willing to look at how everyone in the practice—from the receptionist at the front desk, to the nurse-practitioner, to the physicians—interacted with each other and with patients. The observer noted how patients were moved through the office, how work was actually done in this office, and how patients were treated. The results highlighted where improvements could be made and also showed what they were doing that was absolutely right,” she said.

As part of this process of looking inward, the practice also had meetings once a week. In addition to the personnel of the practice and the facilitator, the meetings included a parent. “I love having a parent as part of the team. The partnership between parents and the medical home is very important,” Dr. Duncan said.

It is essential to be able to learn what is on the parent's mind. The logical way to assess this is via questionnaires, but the practice team must be alert to those parents who may have difficulty filling out these questionnaires for one reason or another.

“One way to make sure we are getting this information is to have the nurse, or physician, or both, ask: “What are you concerned about today? Once we learn the parents' concerns, we then have to make sure we address them,” she said. Other strategies include:

▸ Use of reminder systems.

▸ Development of a registry of patients who have special health care needs.

▸ Use of questionnaires at every visit to ask about parental and youths' concerns.

▸ Use of a confidentiality policy for teens.

▸ Use of a list to prompt essential preventive services.

▸ A referral follow-up system.

“The way to make improvements is to get the whole office involved, and to get everybody working together,” she said.