RESIDENT LED INITIATIVES TO IMPROVE ADOLESCENT IDIOPATHIC SCOLIOSIS (AIS) SCREENING

Purpose: Scoliosis is a common problem in adolescence, affecting 2-3% of the population in both genders, with the age of onset occurring at 10-15 years of age. The American Academy of Pediatrics (AAP) recommends universal screening for AIS beginning at 13-14 years of age for males and at 10-12 years of age for females, citing previous studies showing the benefit of early screening. However, the US Preventive Services Task Force (USPSTF) 2018 guidelines do not recommend routine screening. Due to these conflicting recommendations, provider confusion is expected, and we felt the need to investigate if screening is being done in our resident run clinic (RCC) and ensure that if performed it is done appropriately. We thus sought to determine our baseline data of AIS screenings performed at adolescent well child checks (WCC) and improve the rate of screening by 25% through a quality improvement (QI) project focused on resident education in our resident run clinic (RCC). Methods: Baseline data from Jan-July 2017 WCC for patients ages 10-15 were reviewed to assess the rates of AIS screening. The Electronic Health Record (EHR) was accessed and data from 140 patients' charts were reviewed. PDSA (Plan Do Study Act) cycles with targeted interventions were done starting Sept 2017 including resident education on the forward bend test, scoliometer use, documentation, and referral guidelines. Additionally, two scoliometers were obtained and EHR modifications done to allow for designated space to document the scoliometer measurement and spinal exam. Post intervention data was collected from 180 patients1 charts over the next 9 months from Sept 2017- May 2018. Results: Baseline preintervention data in adolescents presenting for WCC (male, female) ages 10-15 years data revealed A1S screening rate of 4.5%. Post-intervention data showed an increase in AIS screening to 12.6%. Conclusions: Our study revealed a low rate of baseline AIS screening in our resident teaching practice. Our efforts to improve the AIS screening did alter the rate; however not as much as intended. We suspect that the conflicting recommendations from AAP and USPSTF likely lead to confusion among trainees and practitioners in our RRC. While an increase in 8.1% was below our goal, this still likely positively impacted a number of adolescents' futures; and, overall it was a learning experience for the residents. It is important that the residents are being taught early in their careers to provide evidence base