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18 Resolving pediatric population-level gaps: success of an inreach model
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  1. John Morehous1,
  2. Cynthia White2,
  3. Dominick DeBlasio1,
  4. Allison Glance2,
  5. Julie Kleiman3,
  6. Srikant Iyer4
  1. 1Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, USA
  2. 2James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, USA
  3. 3Cincinnati Children’s Hospital Medical Center, USA
  4. 4Children’s Healthcare of Atlanta, Emory University School of Medicine, USA

Abstract

Background Primary care settings have implemented processes to resolve population-level care gaps, including patient reminders, health record prompts, and outreach to patients/families. When patients present outside of primary care but still within the larger health system, these primary-care based processes are not applied, and opportunities to resolve care gaps are missed. We hypothesized that we could resolve care gaps outside the primary care setting by creating an ‘inreach’ process within the larger healthcare system.

Objectives Among children 2–66 months of age within our primary care registry, we aimed to identify and resolve care gaps for children admitted to the hospital medicine service, Our goal was to contact the inpatient team for at least 80% of these patients, and to increase the percent of care gaps closed from 30% to 50%.

Methods A multidisciplinary team of physicians, nurses and improvement experts mapped the baseline process. Failure modes were predicted, and a key driver diagram was developed. Through multiple PDSA cycles, we designed and tested a prototype inreach process. We then operationalized this process for patients admitted to the hospital medicine service, and focused on weekly failures to achieve process reliability.

Results Assessments of care gaps increased from 0% to 88% by the end of December 2018. The percentage of care gap resolution has increased from 30% to 40%.

Abstract 18 Figure 1
Abstract 18 Figure 1
Abstract 18 Figure 2
Abstract 18 Figure 2

Conclusions Using QI methods, a new process to help improve population health for children can be successfully implemented outside of the traditional domain of primary care.

https://doi.org/10.1136/bmjoq-2019-ihi.18

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