411 - Can use of an autotext lead to a cultural change in an ambulatory pediatric primary care practice?

Poster Number: 411

Jill S. Cioffi, Stony Brook Children's Hospital, quogue, NY, United States; Carolyn Milana, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, United States

Background: Childhood immunizations and preventative care are a mainstay of pediatric primary care. In 2017, we found on a chart review that 50% of acute care visits had no review of vaccine or well care status. Investigating further, several charts showed deficiencies in either well care visits, vaccines or both.

Objective: Since no formal process existed, the goal of this quality improvement (QI) project was to develop a process to incorporate status review of vaccine and well care at all acute care visits. Our SMART (Specific, Measurable, Applicable, Realistic, Timely) aim was to have providers review, document and correct (when needed) well care and immunization status during all acute care visits (with a compliance goal of 90%).

Design/Methods: To achieve our goal, we created autotexts to be added to the documentation of an acute care visit and serve as a prompt for providers to check if a patient was up to date or deficient in well care, immunizations or both (Figure 1). Education on the importance of recognition of a patient’s status and use of the autotexts was done at division meetings. Charts were audited monthly and multiple iterative PDCA (Plan, Do, Check, Act) cycles were completed to improve compliance. Communication regarding our process was sent via email and the division’s overall progress was shared at monthly meetings.

Results: Following education and the rollout of our autotext we saw our compliance rates increase from 50% to just below 90% (our goal). Many communications about our QI project were sent, but it was not until October 2020 when we changed our communications to be provider specific (an email was sent to any provider who failed the audit) that we saw sustained improvement. Once our threshold was met (December 2020) encouraging monthly emails were sent congratulating our division. Since December 2020 we were able to achieve and maintain our goal. Of note, our lowest compliance, April 2020, occurred during our county's surge in COVID-19 cases. (Figure 2)Conclusion(s): Although providers agreed good patient care included knowledge of well care status and immunizations, prior to our QI project it is unclear how often a patient’s status was known. In addition, even after we started a formal QI process it took almost 3 years to achieve and sustain our target (90% compliance). True process improvement required a cultural change and only occurred after we instituted monthly communication to individuals regarding their specific audit results, quick feedback to providers below our 90% threshold, as well as positive reinforcement and celebrations of our successes.
Figure 1: Autotexts used by providers to document well child care and immunization status.
Figure 2: Monthly compliance of auto text use across primary care divisionSustained process improvement required a cultural change and prompt feedback to those will failed to meet our 90% compliance goal.