Making the grade with quality reports

Abstract

The current volume of The Journal includes a study from Fogel et al at Penn State, which reports on the results of a quality improvement study at their institution. These workers aimed to improve adherence with current guidelines on lead screening in children in some of their affiliated practices. The study found that an educational intervention produced very little change in practitioner behavior, as assessed by medical record documentation of appropriate lead testing. However, introduction of a point of care (POC) testing device in one of the clinics resulted in striking and durable improvement in screening. Quality improvement initiatives are ubiquitous in children's hospitals these days, and clearly provide value added to the children and families served. However, we rarely publish single-center studies such as this one. We believe that QI initiatives are generally specific to the institutions conducting them, and rarely have the type of generalized impact that we like to see in manuscripts we publish. That being said, there were 3 reasons we believed that this study was appropriate for The Journal. First, of course, the problem was important. Beyond that, the study was very nicely designed, undertaken, and reported. As such, it can provide a model for such reports in the future. Finally, the report drives home a common observation in quality intervention science. "Education," while admirable, rarely produces lasting changes in behavior. Meaningful change in provider behavior in this study only occurred when a novel intervention (a technology) made it possible to change a process, making it easy for the test to be ordered and performed while the child was still in the clinic. Article page 206 ▸ Point-of-Care Testing Improves Lead Screening Rates at 1- and 2-Year Well VisitsThe Journal of PediatricsVol. 233PreviewTo increase blood lead level screening rates in children at 12- and 24-month well visits through provider education and the implementation of a point-of-care (POC) lead screening program in 4 primary care practice offices located in and neighbored by counties with ≥5% prevalence of blood lead levels ≥5 μg/dL. Full-Text PDF