Children’s Preventive Healthcare Initiative

Oregon Medical Professional Review Organization
Portland, Oregon, USA

Stacy D. Aguas RN, MBA, Contract Manager
Anita Bobinet PhD, Project Coordinator
Kathy Phipps, RN, BSN, CPUR, Project Coordinator
Pat Emmerson MS, Communication Specialist


Increase well child care (WCC) visits and immunization rates for children enrolled in Washington Medicaid’s Healthy Options by 10 percentage points.



  • Well child care (WCC) visit rates
  • Immunization rates


Of the 11 clinics that participated in CPHI, 9 completed at least one quality improvement project using the Model for Improvement. All of the projects were aimed at improving either WCC or immunization rates. Each clinic designed an implemented it’s own test of change. Changes include the following:

Well Child Care Changes
  • Developed postcard and telephone outreach to parents of infants and children overdue for a WCC
  • Developed a telephone outreach system for adolescent girls 14 – 16 years of age who were overdue for a WCC
  • Offered incentive to parents for making and keeping WCC appointment
  • Developed a process where physicians and nurses reminded the parent to schedule WCC at sick visits
  • Developed bilingual reminder postcards
  • Adopted the state WCC charting tool
  • Combined WCC and sports physicals
  • Developed a system to identify the children overdue for WCC using clinic billing data or managed care plan data
Immunization Changes
  • Increased immunization rate using CHILD Profile (Washington state immunization registry) to track immunization status
  • Initiated reminder letters for children overdue for immunizations
  • Added populating CHILD Profile to medical assistant’s job description
  • Held community walk-in immunization clinics
  • Combined immunization reminder with WCC reminder




graph_skagitvalleymedicalcenter_success rate in scheduling apppointments, by reminder methods.jpg




Graph_seamarcommunityhealthcenter(vancouver) _cycle2successrateunschedulingappointments.jpg





Summary of Results / Lessons Learned / Next Steps
CPHI established a unique cooperative effort in which state policymakers, health plan representatives and frontline clinic staff worked together toward the common goal of improving health care for Washington’s Medicaid children. A key component was that the exchange of information was fluid and productive across participants, and clinics helped one another on their individual QI projects. 

  • Involve a project champion that is onsite and has passion for the topic.
  • Have administrators sign a memorandum of support (MOU).  This is important for garnering time and resources needed for the project.
  • Identify key team members.  Team members may not need to participate in all levels of the project but those directly involved in the process need to be engaged.
  • Communicate with other staff regularly so that they understand the projects’ value and so that changes can be sustained.
  • Anticipate challenges for obtaining data and address them early. Most clinics did not know that getting the needed data could be difficult and may cause delays in starting the project.
  • Use rapid cycle changes. This enables the clinic staff to try something on a small group of patient and get immediate feedback.
  • Test interventions on small groups first, rather than on the entire population.  This allows you to develop the processes necessary to support the larger group.
  • Share your failures as well as your successes. Others may be able to identify why you failed and help you find the right approach.
  • Use approaches that have worked for others.
  • Spread your successes from one age group to other age groups.
  • Good natured competition makes the project more fun. When more than one clinic site is doing the same project, post the results so they can see how the others are doing.


Contact Information

Stacy D. Aguas, RN, MBA
Contract manager



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