Past QI Projects

Developmental Screening Cohort 2

In 2006, the American Academy of Pediatrics endorsed developmental screening of young children with a standardized screening tool as a routine component of well-child care[1]. Research indicates that identification of developmental delays as early as possible is crucial to supporting early childhood development[2].  Data from 2011-2012 indicate that only 31% of NH parents reported completing  a standardized developmental, behavioral, or social delay screening tool for their child during a health care visit in the past year[3].

This NHPIP and the NH Citizens Health Initiative are currently supporting a second cohort of clinics in a developmental screening quality improvement learning collaborative. To learn about results from the first cohort, click here.

The learning collaborative is a 6-month quality improvement project from November 2016-April 2017. Three clinic sites are participating in the learning collaborative: Wolfeboro Pediatrics, and Dartmouth-Hitchcock Manchester and Bedford.

The target goals are by the end of the learning collaborative, to increase the proportion of children:

  1. with 9, 18, and 30 month well-child visits in the past month where a standardized developmental screen was completed (Target: 80%) (process measure)
  2. with a failed score on a standardized developmental screening instrument  who have a documented clinician referral for additional services. (Target: 70%) (outcome measure)
  3. who turned one in the past month and were screened for developmental concerns using a standardized instrument.  (Target: 80%) (outcome measure)

Two additional intermediate outcome measures will be tracked: the proportion of children who turned two and proportion of children who turned three in the past month screened for developmental concerns. Changes in care systems and satisfaction with the Learning Collaborative design will also be measured.

Funding for the collaborative was provided by the Fund for Tomorrow: Youth and Children in New Hampshire of the New Hampshire Charitable Foundation.

[1] American Academy of Pediatrics.  Identifying Infants and Young Children With Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening.  Pediatrics July 2006; 118:1 405-420; doi:10.1542/peds.2006-1231.

[2] J. P. Shonkoff and D. A. Phillips (eds.), From Neurons to Neighborhoods: The Science of Early

Childhood Development. Washington, D.C.: National Academy Press, 2000.

[3] Child Trends Data Bank.  Screening and Risk for Developmental Delay: Indicators on Children and Youth. July 2013.  Downloaded December 10th at http://www.childtrends.org/wp-content/uploads/2013/07/111_Developmental-Risk-and-Screening.pdf.

HPV Immunization Cohort 2 (March 2016-November 2016)

This was the second cohort of the National Immunization Project with the Academic Pediatrics Association (NIPA) quality improvement learning collaborative to improve adolescent human papillomavirus (HPV) immunization rates in pediatric primary care settings.  Twelve states, including NH, were invited to participate in this six-month QI intervention from March 2016-November 2016. The NH Pediatric Improvement Partnership (NHPIP) facilitated the recruitment of NH practices to participate in this learning collaborative.  Recruited practices received training in QI methodology and implemented evidence-based practice changes to increase immunization rates and reduce missed opportunities for HPV vaccine administration. NH pediatric primary care practices that took part in this project include:

  • Monadnock Regional Pediatrics
  • Epsom Family Medicine

Funding for this project came from the Centers for Disease Control and Prevention-Academic Pediatric Association (CDC-APA) Partnership.

Final report coming soon!

Neurology Tele-health (March 2015-August 2016)

The NHPIP collaborated with NH Family Voices, NH Special Medical Services, Dartmouth-Hitchcock Center for Telehealth and Dr. Richard Morse, a pediatric neurologist at Children's Hospital at Dartmouth to enhance access to appropriate care and improve the capacity of neurology and primary care providers to effectively co-manage children and youth with epilepsy residing in medically underserved/rural areas of NH. The project timeline was from March 2015- August 31, 2016.

The participating practices were:

  • Coos County Family Health Services, Berlin
  • Coos County Family Health Services, Gorham
  • Dartmouth-Hitchcock Keene
  • Dartmouth-Hitchcock Plymouth

The project activities included:

  • Conducting a baseline assessment of technology and clinical training needs relative to pediatrics epilepsy care.
  • Developing, implementing, and evaluating a teleconsult process to facilitate a shared care plan for children with epilepsy involving both the child’s primary care provider and pediatric neurologist. Target:  3 tele-consults per clinic.
  • Offering and evaluating two trainings to build clinician knowledge/skill relative to pediatric epilepsy care.
  • Preparing systems and initial protocol to pilot telehealth patient visits.
  • Developing a web-based “toolbox” of provider and family resources for diagnosing and managing a child with epilepsy.

Oral Health (June 2015-May 2016)

Executive Summary

Final Report

The The American Academy of Pediatrics (AAP) currently recommends the following oral preventive care services be provided as part of routine primary care practice: periodic oral health risk assessments, fluoride supplementation and administration for children meeting certain criteria, well as anticipatory guidance to promote regular tooth brushing, reduced sugar consumption, identification of a dental health home by age one, and monitoring of child brushing until age eight.[4] National data suggests that though pediatricians affirm the importance of delivering oral preventive services, their actual delivery of those services is sub-optimal. NH specific data is unavailable.Though the NHPIP Steering Committee (including many providers, commercial health insurers, state programs, and advocacy groups) has identified oral health as an opportunity for QI work in pediatric primary care settings, state-specific barriers to oral preventive service delivery are not completely clear.  Medicaid payment limitations were noted as one barrier during NHPIP conversations with stakeholders, but the broader range of issues and possible strategies are not completely understood.  The NHPIP's oral health project seeks to fill these information gaps in order to define a strategy to optimize the delivery of oral preventive services in pediatric primary care settings through QI. 

The goals of this planning grant were to:

1) assess the current status of and barriers and facilitators to the delivery of oral preventive services in pediatric primary care practices in NH, with a particular focus on children under six years, and

2) identify strategies to optimize the delivery of oral preventive services in  pediatric primary care settings.

This project was funded by the HNH Foundation.

[4] American Academy of Pediatrics.  Policy Statement on Maintaining and Improving the Oral Health of Young Children.  Pediatrics. Vol. 134(6); 2014: 1224 -1229.

HPV Immunization Cohort 1 (June 2015-May 2016)

Final report

The Academic Pediatrics Association (APA)  and the National Improvement Partnership Network (NIPN) collaborated to offer a quality improvement learning collaborative to improve adolescent human papillomavirus (HPV) immunization rates in pediatric primary care settings.  Five states, including NH, were invited to participate in this nine-month QI intervention from June 2015-May 2016. The NH Pediatric Improvement Partnership (NHPIP) is facilitating the recruitment of NH practices to participate in this learning collaborative.  Recruited practices  received training in QI methodology and implemented evidence-based practice changes to increase immunization rates and reduce missed opportunities for HPV vaccine administration. NH Pediatric primary care practices taking part in this project included:

  • Dartmouth-Hitchcock Concord
  • New London Pediatric Care Center

Funding for this project came from the Centers for Disease Control and Prevention-Academic Pediatric Association (CDC-APA) Partnership.

Developmental Screening Cohort 1 (November 2014-July 2015)

In 2006, the American Academy of Pediatrics endorsed developmental screening of young children with a standardized screening tool as a routine component of well-child care[1]. Research indicates that identification of developmental delays as early as possible is crucial to supporting early childhood development[2].  Data from 2011-2012 indicate that only 31% of NH parents reported completing  a standardized developmental, behavioral, or social delay screening tool for their child during a health care visit in the past year[3].

In July 2015, the NHPIP completed a nine-month developmental screening learning collaborative, which supported 4 pediatric and family practice primary care practices at 7 sites in implementing the Ages and Stages Questionnaire (ASQ) at the 9, 18, and 30 month well-child visits. Results were very encouraging; among eligible children under one year, mean screening rates across all practices increased from 0.5% at baseline to 70.5% at month nine (see image).  

The participating practices were:

  • Cheshire Medical Center/Dartmouth-Hitchcock Keene
  • Core Pediatrics
  • Dover Pediatrics
  • Monadnock Regional Pediatrics
 

Final report coming soon!