Putting Neuromotor Screening Into Practice

1. Putting Neuromotor Screening Into Practice Informational Webinar February 19, 2013

3. Neuromotor Screening Background • General developmental screening at specific ages 9, 18 and 30 months is recommended by the AAP and Bright Futures • In an effort for improved identification of autism spectrum disorders, autism screening is recommended at 18 and 24 months • The most common developmental screening instruments have not been validated on children with motor delays • Gross motor delays are common and vary in severity and outcome; however, specific motor screening is not routinely completed • Feedback from AAP members indicates: • Widely varying approaches to motor examinations and identification of delays • Physicians expressed uncertainty regarding their ability to detect, diagnose, and manage motor delays in children • A clinical report and algorithm has been authored to guide pediatricians regarding an approach to children who demonstrate motor delays and variations in muscle tone

4. Neuromotor Screening Algorithm Routine Developmental Surveillance Developmental screening at the 9,18, 30 & 48 months visits with assessment of child’s motor development Administration of screening tools Documentation of expanded history Neurologic examination Testing and evaluations CK, TSH testing Possible neuroimaging Referral and care coordination Early Intervention Subspecialist evaluation Embargoed

5. Project Overview Conducted by the AAP Practice Improvement Network of the Quality Improvement Innovation Networks at the AAP Partnership with the Program to Enhance the Health and Development of Infants and Childrenthrough a cooperative agreement with the CDC/NCBDDD Up to 30 practices to participate, 1 lead physician identified from each practice Provide practice teams with strategies, tools, and resources necessary to improve neuromotor screening in practice Patient population: practices who have a large number of patients under the age of five are more likely to encounter a child with a motor delay during the course of the project Six-month practice involvement

6. Project Overview • Project Goals • Determine if physicians are able to follow the algorithm and whether the algorithm is helping to accurately identify children with motor delay • Obtain feedback on the use of the algorithm in practice • Follows Institute for Healthcare Improvement Web & Action Model • Pre-work period, including pre-survey • Series of 3 Webinars and Action Periods • Post-survey • Data Collection/Measurement • Pre and post survey • Action plan brief surveys (3)

7. High Level Project Timeline

8. Practice Selection • Lead physician from each practice, but others in practice can/should participate • Up to 30 practices will be selected • Looking for practices to represent diversity • Practices notified on March 1, 2013 with additional project details

9. Benefits of Participation • Test algorithm prior to widespread dissemination and provide feedback to contribute to future refinement of AAP policy • Free printed copy(ies) of the final clinical report and algorithm • Participating lead physicians will receive $25 Starbucks gift cards upon full completion of the project • Work with colleagues from around the country • Learn from national experts • Assist others in implementing the algorithm in practice by sharing lessons that can be distributed beyond this project

10. What to Expect • Complete pre-work • Review background information/pre-work packet • Complete pre-survey • Sign and return participation agreement (by March 27) • Participate on three 55-minute Webinars • Receive education • Provide feedback • Participate in three action periods • Complete assigned action plans • Provide feedback through brief survey • Follow-up period • Participate in follow-up conference call • Complete post-survey

11. Webinar Topics and Dates 55-minute webinars/30-minute follow-up conference call Provide education on clinical content and feedback on action plans/algorithm Agendas and reminders sent prior to each Webinar

12. Action Plan Topics Action plans accompanied by brief feedback surveys Discuss action plans and provide feedback on Webinars and follow-up conference call

13. Next Steps • February 27, 2013: deadline to submit your participation information • March 6, 2013: practices (lead physician) provided project information • March 6-27, 2013: pre-work period • Review pre-work packet • Sign and return participation agreement • Complete pre-survey by March 25, 2013

14. Next Steps Continued

15. Contact Us! American Academy of Pediatrics Jill Healy, MS, QuIIN Program Managerjhealy@aap.org | 800/433-9016, ext 7122 Rachel Daskalov, PEHDIC Program Managerrdaskalov@aap.org | 800/433-9016, ext 7863 Pat Heinrich, RN, MSN, Quality Improvement Advisorpat@heinrichllc.com | 617/686-6161 AcknowledgementThe development of the clinical report and algorithm that are being tested as part of this project was funded by the American Academy of Pediatrics through the Public Health Program to Enhance the Health and Development of Infants and Children through a cooperative agreement (5U58DD000587) with the Centers for Disease Control and Prevention’s National Center on Birth Defects and Developmental Disabilities.

16. Questions