Only half of children are fully ready for kindergarten, and only 42% of 3- and 4-year-olds are enrolled in preschool in North Carolina. However, early childhood well visits can support optimal health and well-being and connect children to the community services they need to become kindergarten-ready.
In 2023, North Carolina Integrated Care for Kids (NC InCK) launched the Kindergarten Readiness Promotion Bundle (KRPB), a novel quality metric of their Alternative Payment Model (APM). The NC InCK APM includes financial incentives for providing and reporting on clinical services and community referral activities that support kindergarten readiness. The measure components include developmental screening, social-emotional screening, fluoride varnish application, and literacy promotion.
To educate practices and improve the delivery of the KRPB components, NC InCK launched a 9-month Kindergarten Readiness Learning Collaborative (July 2023 – March 2024) consisting of quality improvement (QI) support, data feedback, and monthly topic-focused webinars across three clinically integrated networks (CIN) in North Carolina.
The Learning Collaborative aimed to increase the percentage of children (from birth to age 6) receiving the KRPB during well visits from 0% to 60%. Collaborative leaders shared best practices along with relevant QI tools to help practices test and assess the impact of process changes. In turn, practices completed baseline and end line surveys and submitted monthly data on how they were using the KRPB code and its components. Providers earned American Board of Pediatrics (ABP) Maintenance of Certification (MOC) Part 4 credit and AMA PRA Category 1™ Performance Improvement Continuing Medical Education (PI CME) credits for participating in three or more Learning Collaborative webinars.
Each Learning Collaborative session focused on a different component of the KRPB:
July: Kickoff and Overview of Kindergarten Readiness Promotion Bundle
August: Connecting to Pre-K
September: Literacy Promotion
October: Parenting Program Referrals and Social/Emotional/Behavioral Screening and Follow-Up
November: Integrating Multiple Screenings to Address Early Childhood Mental Health
December: Sustaining Change and Exploring New Partnerships
January: Supporting Oral Health
Overall, 15 practices from across three health systems participated in the Learning Collaborative. Practices used various strategies, including building partnerships with community-based resources and standardizing clinic workflows for referrals to improve their KRPB participation. Future work is still needed to study the sustainability of these efforts and determine the impact of primary care-based kindergarten readiness efforts.
Author:
Sara Bryk, MPH: graduated in 2024 from the University of North Carolina (UNC) at Chapel Hill with a Master of Public Health degree and a concentration in Maternal, Child, and Family Health. She also received a Certificate in Improvement and Implementation Science and was awarded the Foreign Language and Area Studies Fellowship for Portuguese and Latin American studies. While at UNC, Bryk served as a graduate research assistant at the World Health Organization Collaborating Center for Research Evidence for Sexual and Reproductive Health, and as a project manager on the Kindergarten Readiness Learning Collaborative at NC InCK. Prior to graduate school, Bryk spent three years as a research analyst at Mathematica, where she provided mixed-methods research and project management support for quasi-experimental evaluations of international development projects. She also spent a year as a Fulbright Teaching Fellow in Colombia and holds a B.A. in human biology and sociology from Scripps College.