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| Research article summary (published 30 May 2009): |
Lowering developmental screening thresholds and raising quality improvement for preterm children.
Full Abstract
OBJECTIVES: Our goal was to determine if (1) preterm children were referred, identified, and received early-intervention/special education services at rates equivalent to term children after implementation of a universal, periodic Ages & Stages Questionnaire screening and surveillance system, (2) pediatricians sufficiently lowered their screening thresholds with preterm children, and (3) quality-improvement opportunities exist. PATIENT AND METHODS: Secondary analysis was performed on 64 lower-risk, predominantly late-preterm and 1363 term children who originally presented for their 12- or 24-month well-child visits. Higher-risk premature infants already involved with an early-intervention agency or identified with a delay were excluded. Board-certified pediatricians (n = 18) and nurse practitioners (n = 2), who were blind to the Ages & Stages Questionnaire results, were secondary participants. Differences between preterm and term early-intervention agency referrals were examined by comparing pediatric developmental impression to the Ages & Stages Questionnaire under natural clinic conditions using a combined in-office or mail-back data-collection protocol. Medical chart and county early-intervention or special education agency follow-up outcomes were conducted at 36 to 60 months. RESULTS: Preterm referral rates were 9.5% (term: 5.6%) with pediatric developmental impression and 26.2% (term: 8.1%) with the Ages & Stages Questionnaire. In follow-up, 37.5% of preterm and 20.8% of term children received referrals, of which 50.0% of preterm and 42.4% of term children were eligible for services, 54.2% of preterm children were identified with a developmental-behavioral disorder, and 29.2% of preterm and 20.8% of term children did not follow-up. For the Ages & Stages Questionnaire, only preterm referrals (55.6%) were subsequently identified with an eligible delay or disorder or both. Preterm children were approximately 2 times more likely to be eligible than term children. CONCLUSIONS: Combined referral, quality-improvement, and outcome data suggest that clinicians should lower their threshold for administering a quality developmental screening instrument when providing surveillance for premature infants. Quality improvement exists with diligent developmental surveillance and a standardized, reliable, but more interpersonal referral process.
Author information
Author/s: Marks, Kevin (K); Hix-Small, Hollie (H); Clark, Kathy (K); Newman, Judy (J);
Affiliation: Department of Pediatrics, PeaceHealth Medical Group, 1162 Willamette, Eugene, OR 97401, USA. kmarks(-atsign-)peacehealth.org
Journal and publication information
Publication Type: Journal Article
Journal: Pediatrics (Pediatrics), published in United States. (Language: eng)
Reference: 2009-Jun; vol 123 (issue 6) : pp 1516-23
Dates: Created 2009/06/01; Completed 2009/06/17; Revised 2009/08/13;
PMID: 19482762, status: MEDLINE (last retrieval date: 8/21/2009, IMS Date: 21 Aug 2009 00:00:00)
Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.
Comments and Corrections
ErratumIn: Pediatrics. 2009 Aug;124(2):846.
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