Reach Out and Read WHFHC, 181 st Clinic Quality Improvement Project 2009-2010 Academic Year.

Reach Out and ReadWHFHC, 181st Clinic

Quality Improvement Project2009-2010 Academic Year

WH ROR TEAM

Minna Saslaw Melanie Gissen Steve Caddle Adriana Matiz Laura Robbins Marina Catallozzi Dodi Meyer Melissa Glassman Mary McCord Anne Armstrong-Coben

MA s

Emelin Martinez Martha Bolivar Dulce Barrios

Emily KottCaroline ChangBen LandisKristen WilliamsRobyn MatloffNefthi SandeepDina FerdmanTed MacnowAmy OstFaith DorseyCrystal SparlingSarah SzlamNeva HowardKim Noble

Project BackgroundReach Out and Read (ROR) is a primary care-based model that was established in 1989 to promote early literacy for children ages 6 months to 5 years. In the U.S., 2 out of 3 children read below their grade level and 90 million adults lack adequate ability to read. The goals of the program are to provide children with age-appropriate books at their well child visits as well as emphasize the importance of reading aloud as an activity shared between parent and child. Studies have shown that parents exposed to the ROR model are more likely to read aloud to their children and that these children score significantly higher on standardized language exams. Currently, nationwide participation has increased to over 4,500 sites, providing more than 6 million books to 3.8 million children.

Project Background•In the exam room, doctors and nurses trained in the developmental strategies of early literacy encourage parents to read aloud to their young children, and offer age-appropriate tips

•The pediatric primary care provider gives every child between the ages of 6 months and 5 years a new, developmentally appropriate children’s book to take home and keep

• In the waiting room, displays, information, and gently-used books create a literacy-rich environment. Where possible, volunteer readers entertain the children, modeling for the parents the pleasures – and techniques – of reading aloud.

Project Background

A provider poll of ~70 faculty/residents at our 4 clinic sites Most providers (80%) at least “mostly familiar”

with ROR model Majority (90%) “often” give age-appropriate books

Only 50% “often” give anticipatory guidance Only 12% “always” give anticipatory guidance

Cited reasons for failing to provide AG Lack of time Forgetting

AIM Statement:Increase provider adherence to the ROR model.

•Increasing provider knowledge on the goals and benefits of the program

•Increasing the number of effective encounters between provider and patient/guardian regarding reading aloud to children at an early age.

Project Goals100% of providers will receive education on the

goals of the national ROR model and training on how to implement them during their patient encounters.

90% of patients, ages 6 mo-5yrs, will receive a developmentally-appropriate book at the well child visit.

50% of families of patients ages 6 mo-5 years will receive effective counseling at the well child visit on the importance of reading aloud to their child and how this experience can positively impact their child's language and development.

50% of patients charts will have consistent documentation of ROR counseling and book distribution at well-child visits.

WH ROR Book DistributionMA s take turns stocking books in exam rooms

Each MA is supposed to check that their exam rooms are fully stocked daily

Every 1-2 months, the MA s call the ROR coordinator to reorder

Total WCC 6m - 5y seen in one-week review

Book given (%)

Patient Ed (%)

Plan (%) AG (%) Pt. ed + plan (%)

Attendings

N=6

59 41 (69) 38 (92) 15 (36) 2 12 (29)

Residents

N=6

31 25 (81) 22 (88) 14 (56) 0 10 (40)

Documentation of book giving at well-child visits in EHR

Measurements, Phase ICompleted October 2009

Home Phone Calls:The Survey

Measurements, Phase IICompleted November 2009

How old is your child? ____ Did your child get a book during your visit today? Yes No Did the doctor explain why they were giving you the book? Yes No If YES, please mark the reasons that they mentioned__ Importance of spending time with family__ Hearing parent voice and sitting with parent__ Improving language skills __ Learning to read__ Learning animals, shapes, numbers, colors, etc__ Other: (please list)_____________________________ Did the doctor explain how to use the book? Yes No If YES, please mark methods explained to you__ Reading aloud or having child read to you__ Using pictures/words for teaching__ Making reading a part of a nightly routine__ Other: (please list) _____________________________

Home Phone Calls:Data Summary

Measurements, Phase IICompleted November 2009

Well Child Care Calls Answered(N=14)

Received Book(N=11)

Yes 11 5

No 3 6

Home Phone Calls:Feedback and Response

Measurements, Phase IICompleted November 2009

•Phone recipient not parent who brought in child to the visit so unsure whether they received the book

•Parental Anxiety: “Why is the doctor calling my home/my work? Is something wrong with my child?”

•Inability to best answer survey questions over the phone: “I know how to read to my child. I do it all the time.”

Waiting Room SurveysDue to barriers obtaining data via home phone

calls, the decision was made to use surveys in the waiting room

Over one week, surveys were handed to each parent of the targeted-age child after finishing the clinic visit

Surveys were handed out by a third party to prevent bias

Measurements, Phase IIICompleted December 2009

Waiting Room Survey Results

Block 6 Block 8 Block 9 Block 10

Book given 85 85 85 88

Explained why?

70 59 82 82

Explained how?

65 71 77 82

Note: Survey not done in Block 7 in order to educate providers about ROR

Longitudinal Analysis of Progress

InterventionsBlock 7 - provider ROR education

Block 8 - anticipatory guidance handouts

Block 9 - acronym expanders

Block 10 & 11 - book stocking charts

ANTICIPATORY GUIDANCE HANDOUT

ACRONYM EXPANDER PHOTO

BOOK STOCKING PHOTOS

Waiting Room Survey Results

Longitudinal Analysis of Progress

Where Do We Go From Here?

Stocking strategiesChart systemDivider system

Anticipatory guidance bookmarks

Anticipatory guidance bookmarks Designed along with national ROR office

Translated into Spanish by Emelin Martinez, Martha Bolivar, and Dulce Barrios

Backtranslated by Adriana Matiz

National ROR office to fund the printing

Eclipsys also to have specific AG

In the meantime Paper handouts in exam rooms with bookmark text Acronym expanders in Eclipsys

Stamper Project – Survey

USE OF THE STAMPER:25% Always33% Most of the Time8% Sometimes33% Never

ELEMENTS USED MOST:66% Consult Notes22% Correspondence11% EI/Disability Evaluations33% Use them all equally

SATISFIED WITH LOOK OF THE STAMP:66% Yes16% Maybe16% No  (reasons included lines are not evenly justified, too large, too complicated)

HAS IT BEEN EFFECTIVE:40% Yes40% Maybe20% No

HOW OFTEN SCANNED INTO PROPER LOCATION:9% Always27% Usually63% Unsure

WOULD IT BE HELPFUL IN OTHER CLINICS:73% Yes27% No

PARTICIPANTS:

6 Attendings2 PGY-1s3 PGY-2s3 PGY-3s

Stamper Project - Study

Tracked all documents to be scanned on 4 separate days

11 of 30 (37%) documents to be scanned were stamped

Of the 11 stamped documents: 3 (27%) made it to the correct folder with the correct title

5 (45%) made it to the correct folder but had no title

1 (9%) made it to the wrong folder and had no title

1 document was not scanned because the same consult note had been scanned into eclipsys 1 month previously