Narrowing Care Gaps for Early Language Delay: A Quality Improvement Study.

Abstract

Poverty is a risk factor for both language delay and failure to access appropriate therapies. The objective of this study was to increase the percentage of children 0 to 3 years old referred from an urban primary care center who attended an initial appointment with speech pathology or audiology within 60 days from 40% to 60%. The Model for Improvement was used to develop and test the intervention, which addressed potential logistical barriers faced by low-income families. Adherence was plotted on run charts in time series to assess overall improvement, and subgroups were analyzed to identify reduction in disparities. Median referral adherence improved from 40% to 60%. Families from lower income neighborhoods had lower preintervention adherence; these differences were eliminated postintervention. System-level changes improved access to evaluation and treatment for low-income children with language delay and narrowed the gap in access between families in lower versus higher income neighborhoods.