Improving Quality Metrics for Adolescents: Lessons Learned from a Clinically Integrated Network’s Regional Quality Improvement Initiative

Introduction: Given the clinical concerns around adolescent mental health and gaps in care exacerbated by the COVID-19 pandemic, a regional, pediatric clinically integrated network developed a systematic, evidence-based initiative to improve outcomes on three adolescent-focused quality metrics. The objective of this study was to implement changes at regional primary care pediatric practices to improve rates of depression screening, vaccination completion, and social determinants of health (SDOH) screening for patients 13-21 years old by 10% from baseline within six months.

Methods: Twenty-six regional practices participated in the 6-month quality improvement project consisting of three rounds of PDSA cycles and educational seminars. Evaluation was completed by reviewing patient records at baseline and then every 2 months for 3 cycles of change. The significance of change for each intervention cycle was compared using the χ2 test of homogeneity or the Fisher exact test.

Results: Statistically significant improvements in depression screening and coding and SDOH screening and coding were demonstrated at cycle one and sustained throughout the six-month study. The vaccine metric did not show statistically significant improvement, likely a consequence of the high baseline rates of meningococcal and tetanus, diphtheria, and pertussis (Tdap) vaccination and the interventions on human papilloma virus (HPV) vaccination focused on timing of dose 1.

Conclusions: Collective PDSA cycles across a regional clinically integrated network can improve depression screening and SDOH screening quality metrics over a six-month period. More time is required to assess impact of interventions on adolescent vaccination rates.