Developmental Surveillance and Screening Policy Implementation Project (D-PIP)

Project Purpose | Practice Teams | Research Methods | Resources for Practices | Q&A

Project Purpose
The Developmental Surveillance and Screening Policy Implementation Project (D-PIP) selected 17 pilot primary care pediatric practices to implement the AAP policy statement, Identifying Infants and Young Children With Developmental Disorders in the Medical Home: An Algorithm for Developmental Surveillance and Screening to determine if the use of the policy, specifically, the algorithm, changes the delivery of developmental surveillance and screening. In particular, the project aims to determine if the algorithm is efficiently and effectively implemented into pediatric practice, recognize strategies for implementing the algorithm, and examine outcomes of implementing the algorithm. Following the project, information will be shared with pediatric clinicians and other health care professionals who are seeking to improve the delivery of developmental surveillance and screening.

A copy of the algorithm can be downloaded by clicking here.

This project will examine the following questions:

1. Can the algorithm be efficiently and effectively implemented into pediatric practice
2. What strategies are used by practices to successfully implement the algorithm (eg, office procedures, time accommodations, follow-up procedures)?
3. What are the outcomes of implementing the algorithm?

Practice Teams
Congratulations to the 17 practices that were selected to participate in the D-PIP! Click here to view a list of practice teams participating in the project.

Practice teams are responsible for:

• Identifying 3 practice team members, one of which must be a pediatrician who will serve as the team leader for this project (Note: completed)
• Choosing a well-defined method of data collection for the practice (eg, chart review, tally-method, administrative systems reporting/EMR, etc) and identifying a practice team member to lead the data collection efforts (Note: completed)
• Participating on a conference call to discuss baseline data collection and reporting (Note: completed)
• Collecting and reporting on baseline data for 1 month using a standard data reporting form (Note: completed)
• Completing a pre-implementation survey (Note: completed)
• Sending the entire practice team to a training/planning workshop (Note: completed)
• Preparing the practice for implementation for 2 weeks following the workshop (Note: completed)
• Implementing an algorithm using strategies determined by the practice team
• Collecting and reporting on data monthly for 9 months following the training using a standard data reporting form
• Maintaining a list of children age 8-36 months who were referred for questions addressed in the post-implementation survey
• Completing a post-implementation survey
• Sharing data and reports with AAP project staff and principal investigator
• If owned by a health care institution, seeking Institutional Review Board approval for participation in the project

Research Methods
The overall design of the project will include:

1. A pre-implementation survey conducted upon practice selection
2. A baseline assessment for 1 month
3. A training/planning workshop / implementation resources
4. A data collection period for 9 months
5. A post-implementation survey
6. Qualitative Interviews

Pre-Implementation Survey
The pre-implementation survey is a method for us to determine the practices’ understanding of developmental surveillance and screening, as well as their current procedures regarding developmental surveillance, screening, and referral.

Baseline Assessment
A baseline assessment will be conducted for 1 month prior to the training workshop. Practices will be required to report data using a standard reporting form that will reflect the type of data each practice will need to collect. The method of data collection will be the individual choice of the practice.

Training/Planning Workshop Photo
A training/planning workshop was conducted for the 17 practice teams on June 16, 2006 to introduce them to the new policy recommendations and algorithm and help them develop a plan for implementation.

Learning objectives include:

1. Establish a clear understanding of the policy implementation project and practice responsibilities
2. Demonstrate a working knowledge of the algorithm and policy statement
3. Provide sample data collection methods and strategies and explain the data reporting tool instructions
4. Develop skills in using appropriate CPT codes for developmental surveillance and screening (96110)
5. Understand confidentiality requirements of the project
6. Identify and outline steps for implementing the policy statement and algorithm into their particular practice

Power Point Presentations

• The Developmental Surveillance and Screening Policy Implementation Project; Paul Lipkin, MD, FAAP Presentation
• Office Systems Change; Paula Duncan, MD, FAAP: Presentation
• Developmental Surveillance and Screening; Paul Lipkin, MD, FAAP Presentation
• Introduction to Policy Statement Algorithm; Nancy Swigonski, MD, MPH, FAAP: Presentation
  
• Developmental Screening Tools; Michelle Macias, MD, FAAP Presentation
• Putting the Office Systems in Place/Overview of Data Collection; Paula Duncan, MD, FAAP: Presentation
• Developmental Screening: Billing and Coding; Michelle Macias, MD, FAAP Presentation
  Sample appeals letter to insurers advocating separate payment for developmental screening Handout
  
• Screening Implementation: Referral and Follow-up; Paul Lipkin, MD, FAAP Presentation

Resources to Help the Practice Change Process

• Improvement Checklist: Steps to Using Screening and Surveillance in Your Office
• Integrating Developmental Screening Worksheet
• Developmental Screening Tools Grid
  (Description | Age Range | No. of Items | Administration Time | Psychometric Properties | Scoring Method | Cultural Considerations | Purchase/Obtainment Information | Key References)

Resources to Implement Practice Changes

• Community Resource Template
• Chart Labels
• Early Intervention Referral Form
• Referral Tracking Worksheet

Monthly Data Collection
Practices will collect data reflecting the algorithm for 9 months.

• Monthly Data Reporting Form (July and March)
• Monthly Data Reporting Form (August through February)
• Data Collection Strategies

Post Implementation Survey

A Post-Implementation Survey will be conducted to determine:

1. If changes were made in the knowledge and delivery of developmental surveillance and screening as a result of the policy statement implementation
2. Strategies used to implement the policy statement/algorithm
3. Outcomes of implementation, benefits of the algorithm process, and barriers encountered
4. Overall evaluation – based on this experience, will your practice continue to do this?

Qualitative Interviews

Recently, the Commonwealth Fund has funded and expansion of the D-PIP that will include qualitative interviews conducted by evaluators from Johns Hopkins University. They will conduct 2 rounds of telephone interviews asking 3 practice team members in each practice about such issues as families' response to screening implementation, the amount of staff effort, time and money required, helpful resources, and disruption to usual patient flow.

Question and Answer (Q&A)

Project Timeline

Bibliography of Practices Implementing Developmental Screening

Additional resources and tools are available by clicking here.

For additional information on the D-PIP, please contact Jill Ackermann, Manager, Medical Home Surveillance and Screening at 800/433-9016, ext 7863 or jackermann@aap.org.

The D-PIP is funded by a cooperative agreement between the AAP and the National Center on Birth Defects and Developmental Disabilities at the Centers for Disease Control and Prevention and a cooperative agreement between the AAP and the Maternal and Child Health Bureau.