Coaching leads to more preventive services

Pediatric practices that have a practice facilitator with public health, primary care, and coaching experience can improve quality of care, particularly with preventive care services, according to a recent study.

Researchers at Case Western Reserve University looked at more than 16,000 patient visits for 6 months at 30 practices in the Cleveland, Ohio, region for 3 preventive services: obesity screening/counseling, lead screening, and dental fluoride varnish application. The coaching began either at the start of the 6-month period, considered Early Intervention, or 4 months after the study began, considered Late Intervention.

The facilitators at each practice spent about 1 or 2 days observing the practice dynamics before calling a group meeting where baseline data were reviewed and goals were set for the services. After the initial meeting, the facilitator would return to the practice on a weekly basis for roughly an hour and provide rapid-cycle feedback.

Before the study began, only 3.5% of Early Intervention patients and 6.3% of the Late Intervention patients were receiving any obesity screening, but after 6 months, both groups had more than 87% of patients taking part in obesity screening. Fluoride varnish application saw a bigger improvement. Few patients received any varnish applications when the study started, but by its end, Early Intervention practices were providing applications to 78.9% of their patients, while Late Intervention practices performed the preventive care on 81.9% of patients. Lead screening increased from 62.2% for the Early Intervention group and 77.8% for Late Intervention patients at baseline to 87.5% and 94.5%, respectively, by 6 months.

Most importantly, the improvement in preventive care was maintained after the facilitators left at the end of the study. When the researchers checked 2 months after the study’s end, the number of patients receiving any of the 3 preventive practices had continued to improve in both Early and Late Intervention practices.

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