Medicaid	Ten Medicaid agencies have used the PHDS tools. These include Florida, Louisiana, Maine, Massachusetts*, Minnesota, Mississippi, North Carolina, Ohio, Vermont, and Washington. For example: v       Washington Medicaid used the PHDS-PLUS to complement their Early and Periodic Screening, Diagnostic and Treatment (EPSDT) measures. It compared differences in the prevalence of parents of young children being counseled on various topics by type of well-visit (EPSDT well-visit rates, chart review, or any type of well-visit). v       Maine Medicaid used the PHDS-PLUS to evaluate the quality of care provided by health care providers enrolled in the Primary Care Case Management (PCCM) program. Findings were inserted into the PCCM newsletter and were used to inform quality improvement priorities for PCCM providers. Secondly, Maine Medicaid used the PHDS-PLUS to evaluate their chart-based encounter forms to guide health care providers and guide future improvement efforts. v       Vermont Medicaid used the PHDS-PLUS and ProPHDS as part of their External Quality Review work focused on measuring and improving preventive and developmental services for young children. Medicaid allowed the Vermont Department of Children with Special Health Care Needs to further analyze the PHDS-PLUS-by special health care need status to evaluate the need for targeted outreach efforts.   * Massachusetts used items from the PHDS-PLUS in their survey.
Health Plans	Four health plans have used the PHDS to collect baseline information to guide quality improvement efforts. For example: v       Three health plans (Kaiser Permanente-Oakland, Alliance, and United) used the PHDS for baseline measurement. v       Kaiser Permanente Northwest (KPNW) collaborated with their pediatric providers to implement the PHDS to collect baseline information and to identify system-level strategies for improvement care.
Providers	Thirty-eight pediatric offices have used the PHDS to gather baseline information and/or to evaluate their improvement efforts. For example: ·          Two pediatric practices in North Carolina used the ProPHDS to guide an improvement effort focused on developmental services. ·          Pediatric health care providers in Vermont implemented the reduced-item PHDS in their pediatric practices to inform their quality improvement efforts. Analyses were conducted at the medical group, office- and provider-level. ·          The Healthy Development Collaborative used the ProPHDS to collect baseline information and to assess whether the improvement efforts resulted in parent-perceived increases in the level and quality of care provided.[1] The Healthy Development Collaborative was a Commonwealth Fund–supported initiative designed to help primary care practices in Vermont and North Carolina engage families in a partnership to promote positive developmental outcomes for the families' children through the development of improved office systems. ·          The pediatrics department of Northwest Permanente Medical Group led the implementation of the PHDS in Kaiser Permanente Northwest. Ten office-level reports and 56 provider-level reports were disseminated within the pediatrics department. The department used the findings to identify improvement strategies focused on (1) addressing topics for which parents have unmet information needs; (2) incorporating standardized developmental screening; and (3) enhancing parental depression screening in pediatric offices. ·          Researchers from the Center for Child and Adolescent Health Policy used the PHDS to evaluate quality of care provision by whether the provider spoke the same language and/or had the same race-ethnicity as the child’s family.
Consumers	The PHDS findings can be reported to consumers (parents of young children in this case). ·          A pilot study was conducted in pediatric practices in Vermont to develop and test feedback templates to parents displaying the findings from the PHDS tools. Overall, the templates were very well received and parents expressed high interest in receiving this type of information.