Table 5.

Descriptions of Interventions to Improve Early Periodic Screening, Diagnosis, and Treatment

Material factors
    EPSDT form revision: the original form was created for billing purposes and was attached to a file before a consultation. We simplified the form and added a reminder function.
    Pediatric worksheet revision: this was a thorough checklist for physicians to use during well-child visits, and included history, physical examination, vaccine information, and screening required for each age-group. We emphasized the required screening at the bottom of the sheet to focus the physician's attention.
Method factors
    Documentation in EHRs: we met with staff, including nurses, and stressed the importance of proper documentation, emphasizing that this should take place even when screening for anemia, lead, vision, or hearing was unsuccessful.
Human factors
    Presentations at grand rounds: to improve awareness, we intermittently presented at these rounds to remind physicians and staff of the screening required at each age.
    Posters in examination rooms: posters were put on the walls of each examination room to act as a reminder to physicians, nurses, and parents of the required screening. It was hoped that this would help parents to remind physicians or nurses to implement screenings that were overlooked.
Mechanical factors
    Screening manual: well-child screening manuals were put on the walls of physicians' rooms showing the screening to be ordered in EHRs. The manual included each item in order.
    Order sets in EHRs: user-friendly ordering sets were created for use by physicians, including for oral health screening.
  • EPSDT, Early Periodic Screening, Diagnosis, and Treatment; EHRs, electronic health records.