P2.O295: Pediatric Spot Vision Screening in Primary Care Pediatric Clinics

Purpose/Objectives: Childhood vision screening improves early recognition and treatment of vision issues. Spot Vision Screening (SVS) has been validated for children 6 months and older. We sought to develop a SVS program to be performed at well child checks (WCC) to address the gap in vision screening for children < 3 years old at our pediatric primary care clinics, using the 9-month-old WCC to assess usage rates. Our specific aim was to increase the percentage of children screened at the 9-month WCC with a SVS from 0% to 70% within 6 months.

Design/Methods: This quality improvement initiative occurred between July 2022 to February 2024 at 5 primary care pediatric clinics at an university- affiliated institution, consisting of 36 primary care pediatricians and associated medical assistants using an electronic medical record (EMR) platform. The stakeholder team included pediatricians, staff and Information Services (IS). Using the model for improvement, after piloting SVS use in one clinic, a cause-and-effect diagram was constructed to inform subsequent interventions, including development of 1) team workflows to incorporate SVS at WCC 2) SVS training modules 3) personalized dashboards in provider’s EMR view that tracked SVS rates and counts at the 9-month-old WCC. Individual clinic, as well as group practice results were tracked monthly in run charts. Outcome measure was SVS completion rate (Pass, Refer, Unsuccessful) and process measure was SVS counts (Pass, Refer, Unsuccessful, Not Attempted, Not Documented). Balancing measures were an estimate of staff time for SVS flows and informal family feedback. Ophthalmology referral rate was also tracked.

Results: A total of 2687 children were eligible for screening. SVS rate after the first month was 69.7% (83/119). Initial implementation median was 70.3%, which increased to a median of 92.8% (Figure 1). SVS count results and personalized dashboards guided identification of screening barriers and sharing of best practices. Balancing measures estimated 3 minutes for staff time for SVS flows and family sentiment was positive. Ophthalmology referral rate was 7.4%.

Conclusion/Discussion: Spot Vision Screening can be implemented across primary care pediatric clinics to provide early identification of vision concerns. Incorporation of a project specific embedded EMR dashboard supports rapid implementation of a new vision screening program. Next steps are to implement these processes across all institutional primary care clinics that care for children.