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No Technological Innovation Is a Panacea: A Case Series in Quality Improvement for Primary Care Mental Health Services

Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, Department of Pediatrics and the Center for Health Policy and Primary Care and Outcomes Research, Stanford University School of Medicine, Stanford, California, sarah.horwitz{at}stanford.edu

Kimberly Eaton Hoagwood, PhD

Department of Psychiatry, Columbia University, New York

Andrew Garner, MD, PhD

Department of Pediatrics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, Department of Pediatrics, Columbro, Greenberg, Carruthers and Garner, University Hospitals of Cleveland system, Cleveland, Ohio

Michael Macknin, MD

Department of General Pediatrics, Cleveland Clinic Foundation, Cleveland, Ohio

Thomas Phelps, MD

Department of Pediatrics, Chesterland Pediatrics, University Hospitals, Chesterland, Ohio

Steven Wexberg, MD

Department of Pediatrics, Cleveland Clinic Beachwood Pediatrics, Beachwood, Ohio

Conrad Foley, MD

Department of Pediatrics, Cleveland Clinic Beachwood Pediatrics, Beachwood, Ohio

Joseph C. Lock, MD

Department of Pediatrics, Cleveland Clinic Beachwood Pediatrics, Beachwood, Ohio

Jacalyn E. Hazen, MD

Department of Pediatrics, Cleveland Clinic Beachwood Pediatrics, Beachwood, Ohio

Raymond Sturner, MD

Center for Promotion of Child Development through Primary Care and the Johns Hopkins University Pediatric Department, Baltimore, Maryland

Barbara Howard, MD

Center for Promotion of Child Development through Primary Care and the Johns Hopkins University Pediatric Department, Baltimore, Maryland

Kelly J. Kelleher, MD, MPH

Department of Pediatrics, Nationwide Children's Hospital and the Ohio State University, Columbus, Ohio

Evaluations of quality improvement efforts targeted at mental health services in primary care pediatrics are rare. We evaluated a short-targeted educational session, a Web-based system, the Child Health and Development Interactive System, and a local area mental health services resource guide. Most physicians believed the information in the educational session was at least somewhat likely to change their practice. However, only 9.2% of the families invited to complete the Web-based system did so. Physicians found access to the Web-based system time consuming and, because the billing code for the screening activity was carved out of most of Ohio's privately-insured contract, physicians received no reimbursement for the screenings. Physicians were unenthusiastic about the local resource guide because the resources were not rated for quality. This quality improvement effort demonstrates that there are not easy solutions to practice change and highlights the need for implementation support when introducing new technology.

Key Words: primary care • mental health • quality improvement

This version was published on September 1, 2008

Clinical Pediatrics, Vol. 47, No. 7, 685-692 (2008)
DOI: 10.1177/0009922808315215


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