HealthDay News — The reliability of delivering a bundle of preventive services to patients aged 0 to 14 months can be improved with innovative redesign, according to a study published online in Pediatrics.

Zeina Marcho Samaan, MD, from the Cincinnati Children’s Hospital Medical Center, and colleagues used quality improvement methodology and determined key drivers in an effort to increase the reliability of delivering a bundle of preventive services to patients aged 0 to 14 months, from 58 to 95% of patient visits. 

The study was conducted in a setting of three academic pediatric primary care clinics (serving 31 000 patients). The bundle included routine vaccine administration, offered influenza vaccination, completed lead screening, completed developmental screening tool, screening for maternal depression and food insecurity, and documentation of gestational age. To drive accountability for components of the ideal flow, they developed patient “Ideal Visit Flow” and the Responsible, Accountable, Support, Consulted, and Informed Matrix. To develop successful interventions, Plan, Do Study, Act cycles were used.

The researchers observed an improvement in the percentage of patient visits receiving all preventive service bundle elements, from 58% pre-intervention to 92% post-intervention.

“Key elements for success were multidisciplinary site-specific teams, redesigned visit flow, effective communication, and resources for data and project management,” the authors write.


1. Samaan ZM, Brown CM, Morehous J, et al. Implementation of a Preventive Services Bundle in Academic Pediatric Primary Care Centers. Pediatrics. 2016;doi: