368 - Integration of Reach out and Read into Electronic Health Record to Scale Systemwide Literacy Quality Improvement

Poster Number: 368
Publication Number: 368.1856

Background: Reach out and Read (ROR) is a national evidenced based program in pediatric primary care that encourages daily reading to increase language development in children 0-5 years old. At NYC Health + Hospitals (H+H), the nation’s largest public hospital system with 55,616 children ages 0-5 years, pediatricians give families books at well child visits (WCVs) to make reading routine. In 2022, a needs assessment across H+H ROR sites identified implementation challenges and best practices. Along with systemwide efforts, a quality initiative was launched at Morrisania’s Pediatric Clinic to improve patient access to program resources, book distribution, and meet reporting requirements.

Objective: Our objectives were to understand ROR program operational challenges and pilot interventions in the electronic health record (EHR) to inform scaling quality improvement initiatives systemwide.

Design/Methods: A needs assessment of 21 of 27 H+H ROR programs conducted through interviews identified data tracking, report submission, and staff knowledge as the biggest challenges. In response, a systemwide EHR smartphrase was optimized and piloted at Morrisania. We worked to increase its utilization through training, incorporating user feedback, integrating it into notes, and regular data sharing. Data on smartphrase use and book distribution was tracked bi-weekly from January to June 2023.

Results: From January to June 2023 at age-appropriate WCVs at Morrisania (n = 1,073), we found an upward trend in smartphrase use by 50% (Fig. 1) and increase in physical book distribution by 49% (Fig. 2). We found a shift in the book distribution rate for Spanish speaking families (Fig. 3) and no substantial change in appointment cycle time. Systemwide, the smartphrase was used across 88% ROR clinics and a dashboard was created to support ROR site reporting. We built a stronger relationship with the larger ROR organization, had 100% of H+H ROR programs submit reports on time, and created a systemwide ROR culture, with sites sharing books and best practices with each other.

Conclusion(s): Our systemwide needs assessment resulted in many successful initiatives to improve ROR programs at H+H. Integration of a smartphrase to track book distribution was an effective way to increase pediatric clinic physical book distribution. Challenges with integration of smartphrase into notes included varying degrees of staff knowledge and non-standardized templates. Since the Morrisania pilot, H+H has implemented the smartphase across all sites and continues to monitor its use and book distribution biannually as part of national ROR reporting requirements.