The Reach Out and Read (ROR) program promotes early literacy as part of pediatric primary care through the distribution of children's books and anticipatory guidance during early childhood.


To improve the rates of age-appropriate book-giving during well-child care and the delivery of ROR-recommended anticipatory guidance in 6 pediatric clinics.


Three quality-improvement cycles were completed at each site. Practice-level data were shared with participants in iterative sessions to identify methods for improving care. A provider-training DVD was used to promote these ROR activities.


Over the course of the project, the median rate of book-giving increased from 97% to 99% and for anticipatory guidance remained at 89%. Providers reported significantly improved ROR-related skills, particularly self-efficacy for modeling reading aloud and for using children's books to assess development.


Baseline adherence to the ROR program is high, possibly because of the ease of implementation. Quality improvement for ROR is feasible and may be easier to implement for book distribution than anticipatory guidance, although providers reported improved anticipatory-guidance skills. Future quality-improvement efforts should continue to address giving books and anticipatory guidance, both of which are integral to the ROR model.

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