Rationale, aims and objectives: In the United States, paediatric patients receive only 41% of indicated preventive services. Past improvement efforts have not bundled preventive services to measure the reliability with which infants' physical, developmental and emotional needs are all addressed. We aimed to create a comprehensive bundle measure that reflects reliable delivery of preventive services during primary care visits, as well as overall preventive service status of a population of patients served by three primary care centres.
Method: Data were collected from electronic health records for cohorts of infants < 14 months old with at least one visit to one of three primary care centres. Immunizations, lead screening, developmental screening and screening for biopsychosocial risk factors (gestational age, parental depression, food insecurity) were chosen by local expert consensus for inclusion in the preventive services bundle measure. Monthly measures of preventive service status at 14 months of age were constructed. A visit-level bundle measure of preventive service delivery was also created. To obtain a baseline for improvement work, bundle completion rates were calculated for infants born in May 2011. Visit-level performance was measured for visits from July to August 2012.
Results: Among 278 patients born in May 2011, 22% of patients received the entire bundle of preventive services by 14 months of age. On a visit level, patients received all indicated services at 58% of visits.
Conclusion: A novel bundle measure can be used to characterize delivery of preventive services and drive improvement at both an individual visit level and a population level.
Keywords: bundle measure; electronic health record; health care quality; infant health; preventive services; well child care.
© 2015 John Wiley & Sons, Ltd.