Child Health Quality Improvement Survey

Thank you in advance for completing this survey on child health quality improvement (QI) opportunities. This survey was developed by the Wisconsin Department of Health Services’ Title V Maternal Child Health Program. Survey results will be used to assist in prioritizing efforts to build a portfolio of QI projects with Maintenance of Certification Part Four credits for pediatric primary care providers. Organizations contributing to this effort include the Wisconsin Chapter of the American Academy of Pediatrics, Wisconsin Association for Perinatal Care, Wisconsin Collaborative for Healthcare Quality, and Children’s Health Alliance of Wisconsin.

1. What is your medical specialty? *This question is required.

Please enter an 'other' value for this selection.

2. What degree did you obtain? *This question is required.

Please enter an 'other' value for this selection.

3. Please rate the importance of each topic to overall child health *This question is required.

Space Cell	Not Important At All	Of Little Importance	Of Average Importance	Very Important	Absolutely Essential
Perinatal depression screening in women and appropriate follow-up after concerning results	Perinatal depression screening in women and appropriate follow-up after concerning results: Not Important At All	Perinatal depression screening in women and appropriate follow-up after concerning results: Of Little Importance	Perinatal depression screening in women and appropriate follow-up after concerning results: Of Average Importance	Perinatal depression screening in women and appropriate follow-up after concerning results: Very Important	Perinatal depression screening in women and appropriate follow-up after concerning results: Absolutely Essential
Timely and recommended follow-up to concerning newborn screening results	Timely and recommended follow-up to concerning newborn screening results: Not Important At All	Timely and recommended follow-up to concerning newborn screening results: Of Little Importance	Timely and recommended follow-up to concerning newborn screening results: Of Average Importance	Timely and recommended follow-up to concerning newborn screening results: Very Important	Timely and recommended follow-up to concerning newborn screening results: Absolutely Essential
Safe infant sleep practices	Safe infant sleep practices: Not Important At All	Safe infant sleep practices: Of Little Importance	Safe infant sleep practices: Of Average Importance	Safe infant sleep practices: Very Important	Safe infant sleep practices: Absolutely Essential
Optimal infant and early childhood nutrition (including breastfeeding)	Optimal infant and early childhood nutrition (including breastfeeding): Not Important At All	Optimal infant and early childhood nutrition (including breastfeeding): Of Little Importance	Optimal infant and early childhood nutrition (including breastfeeding): Of Average Importance	Optimal infant and early childhood nutrition (including breastfeeding): Very Important	Optimal infant and early childhood nutrition (including breastfeeding): Absolutely Essential
Developmental screening and appropriate follow-up after concerning results	Developmental screening and appropriate follow-up after concerning results: Not Important At All	Developmental screening and appropriate follow-up after concerning results: Of Little Importance	Developmental screening and appropriate follow-up after concerning results: Of Average Importance	Developmental screening and appropriate follow-up after concerning results: Very Important	Developmental screening and appropriate follow-up after concerning results: Absolutely Essential
Autism screening and timely referral to supports and services	Autism screening and timely referral to supports and services: Not Important At All	Autism screening and timely referral to supports and services: Of Little Importance	Autism screening and timely referral to supports and services: Of Average Importance	Autism screening and timely referral to supports and services: Very Important	Autism screening and timely referral to supports and services: Absolutely Essential
Lead screening and appropriate follow up after concerning results	Lead screening and appropriate follow up after concerning results: Not Important At All	Lead screening and appropriate follow up after concerning results: Of Little Importance	Lead screening and appropriate follow up after concerning results: Of Average Importance	Lead screening and appropriate follow up after concerning results: Very Important	Lead screening and appropriate follow up after concerning results: Absolutely Essential
Optimal nutrition and physical activity in childhood and adolescence	Optimal nutrition and physical activity in childhood and adolescence: Not Important At All	Optimal nutrition and physical activity in childhood and adolescence: Of Little Importance	Optimal nutrition and physical activity in childhood and adolescence: Of Average Importance	Optimal nutrition and physical activity in childhood and adolescence: Very Important	Optimal nutrition and physical activity in childhood and adolescence: Absolutely Essential
Social determinants of health screening and referral to supports and services	Social determinants of health screening and referral to supports and services: Not Important At All	Social determinants of health screening and referral to supports and services: Of Little Importance	Social determinants of health screening and referral to supports and services: Of Average Importance	Social determinants of health screening and referral to supports and services: Very Important	Social determinants of health screening and referral to supports and services: Absolutely Essential
Integrating targeted disparities interventions into care delivery	Integrating targeted disparities interventions into care delivery: Not Important At All	Integrating targeted disparities interventions into care delivery: Of Little Importance	Integrating targeted disparities interventions into care delivery: Of Average Importance	Integrating targeted disparities interventions into care delivery: Very Important	Integrating targeted disparities interventions into care delivery: Absolutely Essential
Adolescent well visits	Adolescent well visits: Not Important At All	Adolescent well visits: Of Little Importance	Adolescent well visits: Of Average Importance	Adolescent well visits: Very Important	Adolescent well visits: Absolutely Essential
Depression screening among adolescents and young adults and appropriate follow-up after concerning results	Depression screening among adolescents and young adults and appropriate follow-up after concerning results: Not Important At All	Depression screening among adolescents and young adults and appropriate follow-up after concerning results: Of Little Importance	Depression screening among adolescents and young adults and appropriate follow-up after concerning results: Of Average Importance	Depression screening among adolescents and young adults and appropriate follow-up after concerning results: Very Important	Depression screening among adolescents and young adults and appropriate follow-up after concerning results: Absolutely Essential
HPV vaccine series initiation and completion	HPV vaccine series initiation and completion: Not Important At All	HPV vaccine series initiation and completion: Of Little Importance	HPV vaccine series initiation and completion: Of Average Importance	HPV vaccine series initiation and completion: Very Important	HPV vaccine series initiation and completion: Absolutely Essential
Teen driver safety	Teen driver safety: Not Important At All	Teen driver safety: Of Little Importance	Teen driver safety: Of Average Importance	Teen driver safety: Very Important	Teen driver safety: Absolutely Essential
Planned and intentional transition of care delivery from pediatric to adult health care for youth and adolescents	Planned and intentional transition of care delivery from pediatric to adult health care for youth and adolescents: Not Important At All	Planned and intentional transition of care delivery from pediatric to adult health care for youth and adolescents: Of Little Importance	Planned and intentional transition of care delivery from pediatric to adult health care for youth and adolescents: Of Average Importance	Planned and intentional transition of care delivery from pediatric to adult health care for youth and adolescents: Very Important	Planned and intentional transition of care delivery from pediatric to adult health care for youth and adolescents: Absolutely Essential
Enter another option	Other: Not Important At All	Other: Of Little Importance	Other: Of Average Importance	Other: Very Important	Other: Absolutely Essential
Enter another option	Other: Not Important At All	Other: Of Little Importance	Other: Of Average Importance	Other: Very Important	Other: Absolutely Essential

4. For each topic below, please rate the likelihood of your participation in a QI project with associated MOC Part Four credit. *This question is required.

Space Cell	Definitely Not	Probably Not	Possibly	Very Probably	Definitely
Increasing perinatal depression screening rates in women and appropriate follow-up after concerning results	Increasing perinatal depression screening rates in women and appropriate follow-up after concerning results: Definitely Not	Increasing perinatal depression screening rates in women and appropriate follow-up after concerning results: Probably Not	Increasing perinatal depression screening rates in women and appropriate follow-up after concerning results: Possibly	Increasing perinatal depression screening rates in women and appropriate follow-up after concerning results: Very Probably	Increasing perinatal depression screening rates in women and appropriate follow-up after concerning results: Definitely
Increasing timely and recommended follow-up to concerning newborn screening results	Increasing timely and recommended follow-up to concerning newborn screening results: Definitely Not	Increasing timely and recommended follow-up to concerning newborn screening results: Probably Not	Increasing timely and recommended follow-up to concerning newborn screening results: Possibly	Increasing timely and recommended follow-up to concerning newborn screening results: Very Probably	Increasing timely and recommended follow-up to concerning newborn screening results: Definitely
Increasing safe infant sleep practices	Increasing safe infant sleep practices: Definitely Not	Increasing safe infant sleep practices: Probably Not	Increasing safe infant sleep practices: Possibly	Increasing safe infant sleep practices: Very Probably	Increasing safe infant sleep practices: Definitely
Increasing optimal infant and early childhood nutrition (including breastfeeding)	Increasing optimal infant and early childhood nutrition (including breastfeeding): Definitely Not	Increasing optimal infant and early childhood nutrition (including breastfeeding): Probably Not	Increasing optimal infant and early childhood nutrition (including breastfeeding): Possibly	Increasing optimal infant and early childhood nutrition (including breastfeeding): Very Probably	Increasing optimal infant and early childhood nutrition (including breastfeeding): Definitely
Increasing developmental screening rates and appropriate follow-up after concerning results	Increasing developmental screening rates and appropriate follow-up after concerning results: Definitely Not	Increasing developmental screening rates and appropriate follow-up after concerning results: Probably Not	Increasing developmental screening rates and appropriate follow-up after concerning results: Possibly	Increasing developmental screening rates and appropriate follow-up after concerning results: Very Probably	Increasing developmental screening rates and appropriate follow-up after concerning results: Definitely
Increasing autism screening rates and timely referral to supports and services	Increasing autism screening rates and timely referral to supports and services: Definitely Not	Increasing autism screening rates and timely referral to supports and services: Probably Not	Increasing autism screening rates and timely referral to supports and services: Possibly	Increasing autism screening rates and timely referral to supports and services: Very Probably	Increasing autism screening rates and timely referral to supports and services: Definitely
Increasing lead screening rates and appropriate follow up after concerning results	Increasing lead screening rates and appropriate follow up after concerning results: Definitely Not	Increasing lead screening rates and appropriate follow up after concerning results: Probably Not	Increasing lead screening rates and appropriate follow up after concerning results: Possibly	Increasing lead screening rates and appropriate follow up after concerning results: Very Probably	Increasing lead screening rates and appropriate follow up after concerning results: Definitely
Increasing optimal nutrition and physical activity in children and adolescents	Increasing optimal nutrition and physical activity in children and adolescents: Definitely Not	Increasing optimal nutrition and physical activity in children and adolescents: Probably Not	Increasing optimal nutrition and physical activity in children and adolescents: Possibly	Increasing optimal nutrition and physical activity in children and adolescents: Very Probably	Increasing optimal nutrition and physical activity in children and adolescents: Definitely
Increasing social determinants of health screening rates and referral to supports and services (examples include screening for food security, homelessness and unsafe housing conditions)	Increasing social determinants of health screening rates and referral to supports and services (examples include screening for food security, homelessness and unsafe housing conditions): Definitely Not	Increasing social determinants of health screening rates and referral to supports and services (examples include screening for food security, homelessness and unsafe housing conditions): Probably Not	Increasing social determinants of health screening rates and referral to supports and services (examples include screening for food security, homelessness and unsafe housing conditions): Possibly	Increasing social determinants of health screening rates and referral to supports and services (examples include screening for food security, homelessness and unsafe housing conditions): Very Probably	Increasing social determinants of health screening rates and referral to supports and services (examples include screening for food security, homelessness and unsafe housing conditions): Definitely
Integrating targeted disparities interventions into care delivery (examples of possible intervention strategies include health literacy screening, patient navigators, culturally targeted education materials)	Integrating targeted disparities interventions into care delivery (examples of possible intervention strategies include health literacy screening, patient navigators, culturally targeted education materials): Definitely Not	Integrating targeted disparities interventions into care delivery (examples of possible intervention strategies include health literacy screening, patient navigators, culturally targeted education materials): Probably Not	Integrating targeted disparities interventions into care delivery (examples of possible intervention strategies include health literacy screening, patient navigators, culturally targeted education materials): Possibly	Integrating targeted disparities interventions into care delivery (examples of possible intervention strategies include health literacy screening, patient navigators, culturally targeted education materials): Very Probably	Integrating targeted disparities interventions into care delivery (examples of possible intervention strategies include health literacy screening, patient navigators, culturally targeted education materials): Definitely
Increasing adolescent well visit rates	Increasing adolescent well visit rates: Definitely Not	Increasing adolescent well visit rates: Probably Not	Increasing adolescent well visit rates: Possibly	Increasing adolescent well visit rates: Very Probably	Increasing adolescent well visit rates: Definitely
Increasing depression screening rates among adolescents and young adults and appropriate follow-up after concerning results	Increasing depression screening rates among adolescents and young adults and appropriate follow-up after concerning results: Definitely Not	Increasing depression screening rates among adolescents and young adults and appropriate follow-up after concerning results: Probably Not	Increasing depression screening rates among adolescents and young adults and appropriate follow-up after concerning results: Possibly	Increasing depression screening rates among adolescents and young adults and appropriate follow-up after concerning results: Very Probably	Increasing depression screening rates among adolescents and young adults and appropriate follow-up after concerning results: Definitely
Increasing HPV vaccine series initiation and completion rates	Increasing HPV vaccine series initiation and completion rates: Definitely Not	Increasing HPV vaccine series initiation and completion rates: Probably Not	Increasing HPV vaccine series initiation and completion rates: Possibly	Increasing HPV vaccine series initiation and completion rates: Very Probably	Increasing HPV vaccine series initiation and completion rates: Definitely
Increasing teen driver safety	Increasing teen driver safety: Definitely Not	Increasing teen driver safety: Probably Not	Increasing teen driver safety: Possibly	Increasing teen driver safety: Very Probably	Increasing teen driver safety: Definitely
Increasing planned and intentional transition of care delivery from pediatric to adult health care for youth and adolescents	Increasing planned and intentional transition of care delivery from pediatric to adult health care for youth and adolescents: Definitely Not	Increasing planned and intentional transition of care delivery from pediatric to adult health care for youth and adolescents: Probably Not	Increasing planned and intentional transition of care delivery from pediatric to adult health care for youth and adolescents: Possibly	Increasing planned and intentional transition of care delivery from pediatric to adult health care for youth and adolescents: Very Probably	Increasing planned and intentional transition of care delivery from pediatric to adult health care for youth and adolescents: Definitely
Enter another option	Other: Definitely Not	Other: Probably Not	Other: Possibly	Other: Very Probably	Other: Definitely
Enter another option	Other: Definitely Not	Other: Probably Not	Other: Possibly	Other: Very Probably	Other: Definitely

5. For any topics you considered important to overall child health but felt you were unlikely to participate in a related QI project, please indicate why:

6. Please list any other child health topics that are of interest for a QI project