Implementation Research posted on January 27, 2010 09:52 Sher Gardner, Ann Hazzard, Joy Smith, Alana Clayton, Terri McFadden-Garden.. Pediatrics, Emory University School of Medicine, Atlanta, GA; Psychology, Georgia State University, Atlanta, GA. BACKGROUND: The pediatrician's ability to identify developmental delays in patients using history and physical alone is poor at best. Several developmental tools have been developed to help pediatricians more accurately and quickly screen for and identify these delays and thus expedite intervention in this population. OBJECTIVE: To determine if implementing a universal developmental screening protocol within a large outpatient training clinic serving high-risk, low-income families increases idenification and referral of developmentally at-risk children. To assess the protocol's impact on resident knowledge of child development. DESIGN/METHODS: In September 2005, a universal developmental screening protocol was implemented in our resident continuity clinic. At well child visits for children ages 4 months through 5 years, parents were asked to fill out the PEDS while waiting to be seen. Charts were pulled for visits before and after the implementation. The number of delays identified before protocol implementation were compared to those identified afterwards. Residents in the continuity clinic using the new protocol were compared to residents in community clinics without a screening protocol. Both groups were given a developmental pre- and post test and their scores compared. We also acquired data on all residents regarding their perceptions of their developmental pediatrics knowledge. RESULTS: In the pre-protocol period (n=281 charts), only 1.4% of children were identified with possible developmental problems and referred for full evaluation as compared to 4.8% of children in the post-protocol period (n= 436 charts), a significant increase. Out of 15 questions, residents answered an average of 8.7 correctly at pretesting and 8.9 correctly at post-testing, with no significant differences between protocol and comparison groups. CONCLUSIONS: The implementation of a developmental protocol did increase identification and referral for full developmental evaluation. It was thus found to be a useful part of our clinical practice. Resident knowledge was not improved with exposure to the screening protocol. Note from Frances Glascoe (PEDS author): It might have been helpful to view whether PEDS implementation increased providers sense that collaboration with parents is valuable, confidence in decision-making about the need for referral, well-child visits attendance rates, and reduced in "oh by the way concerns". (See other studies abstracted on this site for supporting research on these issues). Still it make sense that trainees wouldn't learn tons about developmental milestones from PEDS-hence, in part, why we created PEDS:Developmental Milestones.