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5A4 Using "Lean" Rapid-Quality Improvement (QI) to Increase Chlamydia Screening Rates in a Large Pediatric Clinic: A Strategy for Engaging Primary Care (PC) in Public Health (PH) QI Priorities

Friday, September 23, 2016: 8:45 AM
Salon C
Holly Howard, MPH1, Laura Kovaleski, MPH1, Lindsey Clopp, MSPH, CHES1, Ina Park, MD, MS1, Serena Yang, MD, MPH2, Christian Faulkenberry-Miranda, MD2, Emily Bahne, PNP-BC, MPH3, Lauren Nelson, MPH1 and Heidi Bauer, MD, MS, MPH4, 1Sexually Transmitted Disease Control Branch, California Department of Public Health, Richmond, CA, 2Department of Pediatrics, UCSF Fresno Medical Education Program, Fresno, CA, 3Children's Health Clinic, Ambulatory Care Center, Fresno Community Regional Medical Center, Department of Pediatrics, Fresno, CA, 4STD Control Branch, California Department of Public Health, Richmond, CA

     

Background:  The PC sector historically reports low chlamydia screening rates, however engaging PC in QI has been challenging. Traditional QI methods require 6-12 months to test and institute new protocols, a demanding commitment for busy clinical practices.  “Lean” rapid-QI methods applied during brief onsite events have been utilized to improve quality and efficiency in other settings and may be effective for engaging PC to partner on PH QI priorities, like chlamydia screening. 

Methods:  In 2015, we engaged a large pediatric clinic in Fresno, California, in a one-week rapid-QI event and provided clinical and QI training to improve chlamydia screening among well-visit patients aged 12-19. Clinician notes and utilization data from one year prior (baseline) and 10 weeks post-event were abstracted from electronic health records (EHRs) and used to identify sexually active (SA) patients and to calculate the proportions of visits with annual standardized SA-status documentation, and annual and same-day chlamydia screening among SA patients. To measure practice impact, we compared average visit lengths at baseline and post-event using EHR time-stamps.  Cross-sectional pre- and post-event staff surveys assessed knowledge, behavior, comfort/confidence, and satisfaction related to provision of adolescent sexual health services; mean %-change in scores were calculated.  We determined statistical significance using 2-tailed Fisher’s exact tests.

Results:  Among eligible baseline (n=240) and post-event (n=106) well visits, standardized SA-status documentation increased from 6% to 58% (p-value<0.0001).  Twenty-seven (11.3%) baseline and 22 (20.8%) post-event patients were identified as SA.  The annual chlamydia screening rate among these patients increased from 44% to 77% (p-value=0.04). Same-day screening increased from 26% to 59% (p-value=0.02). Visit lengths across time-periods remained consistent. Clinic staff surveyed pre- (n=49) and post-event (n=54) demonstrated percent improvements in knowledge (48.9%,p-value=0.0001), behavior (19.4%,p-value=0.03), comfort/confidence (41.7%,p-value=0.0001), and satisfaction (22.9%,p-value=0.03).

Conclusions:  Offering Lean rapid-QI support can be a successful PH strategy for engaging PC in chlamydia screening QI efforts.

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