Improving Referral Adherence in a Developmental/Behavioral Clinic: A Quality Improvement Initiative.

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Introduction: Multiple studies have noted significant rates of emotional and developmental concerns in children, coupled with inconsistent rates of engagement with related services. Such inconsistency can lead to a range of negative outcomes. Our project aimed to increase the number of children who completed the intake process following referral to the Child Development Center from 57% to 80% by the end of the second quarter of 2022. Methods: The project team identified barriers to referral adherence and developed targeted interventions to address them. Plan-Do-Study-Act cycles included interventions such as moving the intake process to a phone call, direct outreach to families, enhancing education on Child Development Center services, and increasing communication with referring providers. We used control charts to assess the impact of interventions. Results: Completed intakes increased from 57% to 85% within 2 months and remained between 83% and 89% for the rest of the study. Referral completion rates for children younger than 5 rose from 45% to 75% or higher. The referral completion rate did not vary by ethnicity, race, or insurance type. Although increased referral completion rate led to increased wait times for appointments, 83% of patients who completed an initial intake followed through with an appointment at the Center. Conclusions: We used a quality improvement methodology to increase the percentage of patients who completed an initial intake following referral to the Center. The use of a phone intake option and consistent seeking of feedback and collaboration with all stakeholders involved in the project contributed to its success.