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Journal Article


Assisting Primary Care Practices in Using Office Systems to Promote Early Childhood Development

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In the Literature


A study of pediatric and family practices in Vermont and North Carolina found that a collaborative quality improvement program helped practices implement systems to provide parents with child-rearing guidance and information on healthy development. It also increased parents' satisfaction with their children's care.

IMPORTED: www_commonwealthfund_org__usr_img_Margolis_ITL_chart.gif

The Issue

Parents need information and support from their children's physicians about healthy development and child-rearing, but recent studies indicate parents do not always receive this guidance. Tools to elicit parents' concerns, like identification of psychosocial risk factors, anticipatory guidance, and problem-focused counseling, are integral to good family care but challenging for busy practices to implement.

Key Findings

  • The mean number of strategies used in the intervention practices increased to 19.4 from 12.9, but did not increase in the comparison group.
  • Intervention practices were more successful at implementing systems to manage care delivery in the office (e.g., guidelines and standard tools to document preventive services) than at employing systems to ensure community linkages.
  • Children across all practices with documented developmental and psychosocial screening increased from 78 percent to 88 percent and 22 percent to 29 percent, respectively.
  • Among intervention practices, the rate of parents reporting an increase in high-quality care increased from 40 percent to 52 percent. There was no change in comparison practices.

Addressing the Problem

IMPORTED: www_commonwealthfund_org__usr_img_Margolis_pull_quote_12_09_08_v2.gif Evidence has shown that providing parental education about physical and development care, using developmental screening tools, and identifying family risk factors like maternal depression or violence in the home can help tailor pediatric care to families' needs. However, developing the systems to deliver that kind of specialized care can be time-consuming. The researchers in this study found that providing assistance to office practices is an effective strategy: practices that received quality improvement support were more likely than those that did not receive such assistance to improve their preventive and developmental services. Future studies, the researchers say, should explore ways to extend such support to larger numbers of practices to more broadly stimulate adoption of such services.

About the Study

The researchers compared 18 primary care practices participating in a 12-month education and quality improvement program with 17 practices that did not. The practices were located in Vermont and North Carolina. The intervention was designed to help practices promote early childhood development services by implementing strategies like standardized tools for screening and anticipatory guidance, using systems to promote preventive and developmental care, and streamlining referrals to community agencies. Practices were surveyed at baseline (June to August 2004) and during a follow-up period (June to December 2005). Parents were also surveyed about care in the past 12 months, using the Promoting Healthy Development Survey.

The Bottom Line

The use of office systems and tools can help primary care practices improve rates of preventive care delivery and parents' satisfaction with care, but many practices will require assistance in developing and implementing such systems.

Publication Details



P. A. Margolis, K. T. McLearn, M. F. Earls et al., "Assisting Primary Care Practices in Using Office Systems to Promote Early Childhood Development," Ambulatory Pediatrics, Nov.–Dec. 2008 8(6):383–87.