Project Context

This QI project took place at PediPlace, a not-for-profit pediatric clinic with 2 main locations in Lewisville and Dallas, Tex. There is also a third school-based clinic at Central Elementary School in Lewisville. PediPlace conducted the initiative at the Lewisville clinic, as it is the busiest of the 3 locations.

As a nonprofit provider primarily serving the uninsured and Medicaid population, PediPlace must follow the Texas Medicaid policy. The Medicaid policy requires parents to change the child’s primary care provider on their insurance card via phone before the end of the visit to ensure that the visit is reimbursed to the correct office. This process includes providing a confirmation number to checkout staff. Though not considered a specific delay during the appointment, this process is time-consuming and adds to the entire appointment length. Texas Medicaid policy also requires the completion of developmental screening questions at each visit through the age of 60 months.

PediPlace sees between 70 and 100 patients daily for sick-child and well-child appointments. About 55% of the patient population identifies as Hispanic or Latino. Four full-time and 6 part-time providers see patients 1–3 days a week. Each provider sees 15–20 patients per day. The clinic has 18 patient examination rooms, 2 triage areas, separate sick and well side waiting rooms, and a front office with 2 check-ins and 2 checkout personnel. PediPlace has 9 medical assistant (MA) positions, 8 of which are currently filled. Each provider uses 2 examination rooms, with an additional shared overflow room. PediPlace uses the NextGen electronic health record (EHR) Interface (NextGen Healthcare, Irvine, Calif.).