Implementation Research posted on January 27, 2010 09:52 Alison Schonwald, Eugenia Chan, Noelle Huntington, Wanessa Risko, Carolyn Bridgemohan. Division of General Pediatrics, Children's Hospital, Boston, MA. BACKGROUND: The AAP advises pediatricians to use standardized developmental screening tools for early identification of developmental needs in children under three, yet few providers have adopted this practice. The Parents' Evaluations of Developmental Status (PEDS) is a validated parent survey to identify children needing further evaluation. OBJECTIVE: To measure changes in identification rates and referrals for developmental/behavioral (d/b) needs after implementing PEDS screening. DESIGN/METHODS: Setting: We implemented the PEDS at Boston Children's Hospital Primary Care Center as a QI initiative. 90 providers care for 12,000 children in 34,000 visits/year. The population is 40% African-American, 35% Latino; 65% qualify for Medicaid/free care. Subjects: Parents of children 6-months to 9-years with well care visits from 1/2/06. Methods: Parents completed the PEDS. We reviewed medical records for 339 children with 2- and 3-year-old well care visits pre-PEDS, and 228 post-PEDS. Abstracted data included identification of d/b needs, referral for evaluation, and PEDS use. Providers documented PEDS use, findings, and responses to concerns identified for each screened patient for the first 9 months of screening. Data were analyzed in SPSS, using one- and two-tailed chi-square and Fisher's Exact Test. RESULTS: Identification of developmental concerns increased (20.7% pre-PEDS to 26.3% post-PEDS, p=.053); the greatest change was in 3 year olds (11.2% to 19.2%, p=.023). We also identified a greater proportion of behavioral concerns (8% to 12%, p=.04), most notably in 2 year olds (7.1% to 14.2%, p=.023). Referral rates for d/b concerns did not change. PEDS use increased from none to 61.5% of children seen. Of the 1861 6m-9yo children screened with the PEDS in 9 months, 12% were referred for further assessment, 8% already received services. PEDS identified 67% of new concerns; provider observation/risk status identified 33%. 74% of those identified by the PEDS were not already receiving services. CONCLUSIONS: Identification rates of toddler d/b needs increased after implementing standard developmental screening. Referral rates did not change, perhaps due to high baseline rates, improved discrimination of referral indications, or management of behavioral concerns within the office setting.