BACKGROUND: Iron deficiency anemia (IDA) is the most common nutrition deficiency among children under 5 years of age and has been linked to neurocognitive adverse effects. Although the American Academy of Pediatrics recommends routine screening in early childhood, the rate of follow up after a positive screen is low. OBJECTIVE: To increase the proportion of patients across 12 pediatric primary care practices with a positive screen for IDA at their 1- or 2-year preventive health visit who have a follow-up complete blood count (CBC) ordered within 4 weeks to 80% between May 2018 and December 2019. METHODS: We used the Institute for Healthcare Improvement model as a framework for this quality-improvement (QI) project. After developing our aim, we identified related key drivers and interventions, and monitored our progress by plotting data from our electronic medical record (EMR) system onto a control chart. We considered a positive screen to be a hemoglobin concentration of <10.5mg/dL and <11.5mg/dL for one- and two-year old children, respectively. We defined our baseline period as between January 2017 and March 2018. We focused first on physician and parent education. Our initial intervention was to develop an algorithm for decision support and establish a uniform process for ordering follow-up CBC when patients were identified as having IDA. We educated our providers on the algorithm and distributed it across the network of practices. Another intervention was the creation of a standardized follow-up communication to parents in the EMR. RESULT: The rate of follow-up testing increased starting April 2018. The Centerline shifted from a baseline of 32.5% to 53.7%. (Figure 1) CONCLUSION: At baseline, the rate of follow-up after a positive IDA screen in these 12 practices was poor. We have evidence of modest improvement from our QI initiative. Although there is more work to be done, our decision support algorithm has been used as a tool for information and education. We continue to collect process data to evaluate for our target goal and areas of improvement.

Figure 1

Control p-Chart