Details

Autor(en) / Beteiligte

• Bryan, Ian L
• Mehlman, Ashley

Titel

Improving the quality of care for foster children in Eastern North Carolina

Ist Teil von

• Pediatrics (Evanston), 2019-08, Vol.144, p.1

Ort / Verlag

Evanston: American Academy of Pediatrics

Erscheinungsjahr

2019

Link zum Volltext

Quelle

EZB Free E-Journals

Beschreibungen/Notizen

• Background and Objectives: There are approximately 250,0000 children placed into foster care annually in the United States. In North Carolina alone there are over 10,000 children in foster care. They are at a disproportionately higher risk of physical, developmental, behavioral and mental health problems relative to any other group of children. The North Carolina Pediatric Society and NC DHHS have partnered together to strengthen the medical home for foster children by developing "Fostering Health NC." Our resident-led quality improvement (QI) project aimed to improve the rate of foster children that are seen by a continuity clinic provider (CCP) for their comprehensive health visit (CHV) within 30 days of entry into foster care to at least 75% and to improve the quality of care by implementing the appropriate screens as recommended by the American Academy of Pediatrics (AAP). Methods: We applied a multi-disciplinary process to increase awareness and improve the comprehensive health care for foster children in our Pediatric Continuity Clinic. Our plan-do-study-act (PDSA) cycles included: PDSA #1: engagement of our clinic social worker in plan to schedule foster children with a CCP; and PDSA #2: increase awareness further by educating our nurses, schedulers, and CCPs. Our data collection was done via electronic medical record chart review. We calculated the percentage of patients that were seen for a CHV, whether that visit was within 30 days of entry into foster care, and whether it was with a CCP. We then compared the data sets before and after implementation of our interventions. Results: Our baseline data showed that 75% of foster children were seen for a CHV within the recommended 30 days from entry into foster care, and but only 54% were seen by a CCP for that visit. During our 1st PDSA cycle, 53% of CHVs were completed and 11% of those were within 30 days and with a CCP. During our 2nd PDSA cycle, 78% of CHVs were completed. Of those, 86% were with a CCP and 28% were both within 30 days and with a CCP. Conclusions: After initial data collection we became aware that our clinic was not meeting the standard of care as outlined by "Fostering Health NC." We implemented an interdisciplinary approach to correct this by involving our clinic social worker and educating our fellow residents, nursing staff and schedulers. Based on the analysis of our first two PDSA cycles, there was an increase in the percentage of CHVs done and an increase in CHVs done with a CCP. However, there is still difficulty in getting the CHV done within 30 days. This points to possible issues outside our clinic and identifies a new venue for outreach, which would be with our local DSS offices.