Managing the COVID-19 Pandemic Using Quality Improvement Principles: A New York City Pediatric Primary Care Experience

Abstract

Introduction: In the setting of COVID-19, pediatric primary care in New York City faced multiple challenges, requiring large-scale practice reorganization. We used quality improvement principles to implement changes to care delivery rapidly. Methods: Plan-do-study-act cycles were used, based on primary drivers of consolidation, reorganization of in-person and urgent care, telehealth expansion, patient outreach, mental health linkages, team communication, and safety. Results: The average visit volume in pediatrics decreased from 662 per week to 370. Telehealth visits increased from 2 to 140 per week, whereas urgent in-person visits decreased from 350 to 8 per week. Adolescent visits decreased from 57 to 46 per week. Newborn Clinic visits increased from 37 per week to 54. Show rates increased significantly for pediatrics and adolescent ( P = 0.003 and P = 0.038, respectively). Conclusions: Quality improvement methodology allowed for the consolidation of pediatric primary care practices during the first wave of the COVID-19 pandemic, ensuring care for patients while prioritizing safety, evidence-based practices, and available resources.

COVID-19 Associated Contact Restrictions in Germany: Marked Decline in Children’s Outpatient Visits for Infectious Diseases without Increasing Visits for Mental Health Disorders

“…This decrease may be due to the avoidance of non-urgent doctor visits because of parental concerns about risks of infection in a doctor’s offices but may also be due to a reduced burden of disease associated with contact restrictions. The observed decrease in the number of cases is significantly lower than the 45% decrease reported from New York City [ 7 ], suggesting a higher level of family confidence in the safety precautions taken in physicians’ offices in Germany. This is also supported by the fact that the number of presentations for chronic physical illnesses, the prevalence of which is unlikely to have been influenced by the pandemic in the short term, decreased only slightly (diabetes by 8%, celiac disease 14%, hay fever 5%).…”

“…A decrease in inpatient treatment cases in children by up to 45% has been reported in the United States [ 5 ] and by 13–16% in Europe [ 6 ]. A 45% decrease in outpatient pediatric treatment cases has been reported in the city of New York [ 7 ]. We analyzed nationally collected data on children’s outpatient visits in Germany with respect to the frequency of medical presentations and selected diagnoses before and during the COVID-19 pandemic to evaluate the health impact of the pandemic on children.…”

The role of primary care during the pandemic: shared experiences from providers in five European countries

“…Such measures are of critical importance in maintaining service delivery and protecting vulnerable patient groups [ 89 , 90 ]. A variety of such measures for primary care have been proposed in the literature [ 5 , 23 , 91 – 94 ]. The primary care providers interviewed for our analysis described several measures from their own practice.…”

Construction of the Enterprise Human Resource Quality Evaluation System Based on the WICS Leadership Model

“…Davi-Mc Clelland, a Harvard University professor, was the rst to introduce the concept of leadership, which was in 1973. According to any traits that can be consistently measured or counted, the notion of leadership refers to a sharp division between outstanding and ordinary people at work, which can be measured or tallied [15][16][17]. Examples of such divisions include work motivation, workplace attitude or values, personality traits and cognition as well as selfimage, expertise in a speci c subject, professional abilities, and so on.…”