Implementation Research posted on January 27, 2010 09:52 Alison Schonwald, Eugenia Chan, Wanessa Risko, Carolyn Bridgemohan.. Division of General Pediatrics, Children's Hospital, Boston, MA. BACKGROUND: Despite recommendations to use validated developmental screening in primary care, many providers are reluctant to change practice. Commonly perceived obstacles are 1) insufficient visit time, 2) inadequate training in developmental services, 3) lack of familiarity with screening tools. OBJECTIVE: To assess changes in provider 1) attitudes toward screening time required, 2) knowledge about tool use, 3) confidence in ability to screen for developmental/behavioral (d/b) concerns, and 4) adoption of validated developmental screening. DESIGN/METHODS: Setting: The PEDS was implemented at a large urban academic center and a community health center. Subjects: 29 pediatric primary care providers (pediatricians, family practitioners, and NPs) were surveyed before and 24 were surveyed after PEDS screening. Methods: Parents of children 6 months-9 years completed the PEDS at well child care (wcc) visits as a QI effort. Providers were educated about the tool in small groups, and expected to review and interpret responses within wcc. Anonymous provider surveys included Likert-scale, true/false, and multiple choice items about attitude, screening practice, and knowledge. Data were entered into EXCEL, analyzed in SPSS. RESULTS: Of 29 baseline respondents (19 staff physicians, 10 pediatric nurse practitioners) 75% were female, practicing an average of 14.3 years (±9.1). Providers did not find screening during wcc time consuming after three months of using the PEDS (mean 2.32±1.92 on 1-5 Likert-scale, ns): at baseline, 17% thought it would take too much time to screen during wcc, decreasing to 4% post-implementation. Providers reported increased knowledge of correct use of the PEDS after 3 months (p=.015) and greater confidence in their ability to screen for d/b concerns vs. baseline perceptions (p=.04). Reported practice changed (mean 2.66±3.46 on 1-5 Likert-scale, p=.03): at baseline, 24% of providers reported using a standard tool at every wcc vs. 58% at follow-up. CONCLUSIONS: Providers did not report increased concerns with time required to screen after 3 months of routine screening. They demonstrated increased knowledge of accurate use of tools and greater confidence in their screening ability. Despite perceived obstacles, routine developmental screening can be incorporated into academic and community based primary care practices.