Alabama’s children achieve better outcomes when challenges in infancy and toddlerhood related to development, autism, social-emotional concerns, and maternal depression are identified and addressed early on. The Best Beginnings collaborative began in January 2020 to support primary care practices in improving their current screening processes or to introduce new screenings into their workflow. Fourteen pediatric practices and 67 pediatricians began orientation, module work and data collection using the American Academy of Pediatrics’ Quality Improvement Data Aggregator with practice interventions aligning around the key drivers of engaging QI team and practice, managing population, building community capacity, reliable screening and referral completion, and parent/guardian engagement. Practices self-selected ONE of the early screening tools (development, autism, social-emotional, or postpartum depression) to change workflow to increase the rate of recommended well-child visit screenings and referral for services for conditions impacting children ages one month to three years. 

This work, however, was interrupted in early March as the nation was hit with the COVID-19 crisis; screening and referral completion paused from March through May to focus on COVID-19 workflow changes while working on early screening, documentation and referral tracking. 

Practices continued to attend the regularly scheduled monthly practice webinars and report out on shared experiences around COVID-19 during the last three months, which included the following: 

Workflow revisions

• Increased well-child visits picked up in early May

• Collaborative practices never suspended early screenings for well-child visits during COVID pivot months

• Triage protocol changed from the triage room to patient rooms

• Practices are seeing a much lower sick visit rate

Staff/Office impact

• Important to stay vigilant for other comorbidities that can be identified through well-child visits

Telehealth

• Heavy use of telemedicine, phone contact, some video

• Telehealth – queries on ADHD, asthma, depression

Reminder/Recall/Connecting to families

• Reminder recalls through several platforms/programs, including phone calls and running reports

• Use of social media and patient portals to encourage well visits and keep families informed of changes

• Practices have been communicating safety measures to families through social media and text messaging

• Messaging to families for follow-up appointments

• Using ImmPRINT for vaccines reconciliation

• Using EHR to connect with families with asthma, ADHD, depression

• Practices have used COVID-19 time to increase outreach to asthma and ADHD patients

Status of routine vaccinations at well visits

• Practices reporting vaccines are remaining stable or actually increasing with well visits.

• Some practices have focused on vaccine visits – one to two times per week; calling patients from call service each night.

This article first appeared in the Second Quarter 2020 Edition of the Alabama Pediatrician Newsletter. See full newsletter here.