Does Well-Child Care Have a Future in Pediatrics?

Coker, Tumaini R.; Thomas, Tainayah; Chung, Paul J.

doi:10.1542/peds.2013-0252f

Cited by 50 publications

(36 citation statements)

References 90 publications

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“…The inclusion of nonphysicians as part of a team approach to care is widely recognized as a key component in preventive care quality improvement and WCC delivery system redesign. 13,[36][37][38] In a recent review of tools and strategies to improve WCC, we found evidence suggesting that inclusion of nonphysician providers into a health care team could improve receipt of anticipatory guidance and developmental and behavioral services. 16,17,[39][40][41][42] In Healthy Steps, a physician and child developmental specialist (typically a nurse, social worker, or early childhood educator) provide WCC in partnership.…”

Section: Discussionmentioning

confidence: 97%

“…[6][7][8][9][10][11] Key structural problems in WCC include: (1) reliance on highlevel clinicians (pediatricians, family physicians, and nurse practitioners) for basic, routine WCC services; (2) limitation to a clinician-directed wellvisit for the wide array of education and guidance services in WCC; and (3) lack of a systematic, patientdriven method for visit customization to meet families' needs. 1,2,[12][13][14][15] Various tools and strategies to redesign the structure of WCC have been proposed and studied; however, there are few evidencebased comprehensive models of care to serve as feasible and sustainable alternatives to the current WCC structure in most small community practices. 16,17 Our comprehensive model (ie, the Parentfocused Redesign for Encounters, Newborns to Toddlers [PARENT]) was developed to address these key structural deficiencies in our current WCC system by decreasing reliance on the physician for routine WCC and shifting many WCC services to a health educator.…”

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confidence: 99%

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A Parent Coach Model for Well-Child Care Among Low-Income Children: A Randomized Controlled Trial

et al. 2016

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OBJECTIVE: The goal of this study was to examine the effects of a new model for well-child care (WCC), the Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT), on WCC quality and health care utilization among low-income families. METHODS:PARENT includes 4 elements designed by using a stakeholder-engaged process:(1) a parent coach (ie, health educator) to provide anticipatory guidance, psychosocial screening and referral, and developmental/behavioral guidance and screening at each wellvisit; (2) a Web-based tool for previsit screening; (3) an automated text message service to provide periodic, age-specific health messages to families; and (4) a brief, problem-focused encounter with the pediatric clinician. The Promoting Healthy Development Survey-PLUS was used to assess receipt of recommended WCC services at 12 months' postenrollment. Intervention effects were examined by using bivariate analyses. RESULTS:A total of 251 parents with a child aged ≤12 months were randomized to receive either the control (usual WCC) or the intervention (PARENT); 90% completed the 12-month assessment. Mean child age at enrollment was 4.5 months; 64% had an annual household income less than $20 000. Baseline characteristics for the intervention and control groups were similar. Intervention parents scored higher on all preventive care measures (anticipatory guidance, health information, psychosocial assessment, developmental screening, and parental developmental/behavioral concerns addressed) and experiences of care measures (family-centeredness, helpfulness, and overall rating of care). Fiftytwo percent fewer intervention children had ≥2 emergency department visits over the 12-month period. There were no significant differences in WCC or sick visits/urgent care utilization. CONCLUSIONS:A parent coach-led model for WCC may improve the receipt of comprehensive WCC for low-income families, and it may potentially lead to cost savings by reducing emergency department utilization.

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Section: Discussionmentioning

confidence: 97%

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confidence: 99%

A Parent Coach Model for Well-Child Care Among Low-Income Children: A Randomized Controlled Trial

et al. 2016

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“…16,[18][19][20] With the advent of retail-based clinics and Internet-based care, 35 a greater burden of chronic disease during childhood, 36 and an increasing need for chronic care management, 37 primary care pediatrics may need to adapt to a more specialty-based model similar to primary care pediatrics in many other developed nations. 38,39 This study has several limitations. First, WCC models were designed specifically for practices involved in the study and may not be generalizable to others.…”

Section: Model 4: Technology-based Modelmentioning

confidence: 96%

Well-Child Care Clinical Practice Redesign for Serving Low-Income Children

et al. 2014

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Our objective was to conduct a rigorous, structured process to create a new model of well-child care (WCC) in collaboration with a multisite community health center and 2 small, independent practices serving predominantly Medicaid-insured children. Working groups of clinicians, staff, and parents (called "Community Advisory Boards" [CABs]) used (1) perspectives of WCC stakeholders and (2) a literature review of WCC practice redesign to create 4 comprehensive WCC models for children ages 0 to 3 years. An expert panel, following a modified version of the Rand/UCLA Appropriateness Method, rated each model for potential effectiveness on 4 domains: (1) receipt of recommended services, (2) family-centeredness, (3) timely and appropriate followup, and (4) feasibility and efficiency. Results were provided to the CABs for selection of a final model to implement. The newly developed models rely heavily on a health educator for anticipatory guidance and developmental, behavioral, and psychosocial surveillance and screening. Each model allots a small amount of time with the pediatrician to perform a brief physical examination and to address parents' physical health concerns. A secure Web-based tool customizes the visit to parents' needs and facilitates previsit screening. Scheduled, non-face-to-face methods (text, phone) for parent communication with the health care team are also critical to these new models of care. A structured process that engages small community practices and community health centers in clinical practice redesign can produce comprehensive, site-specific, and innovative models for delivery of WCC. This process, as well as the models developed, may be applicable to other small practices and clinics interested in practice redesign. Pediatrics 2014;134:e229-e239 Dr Coker conceptualized and designed the study; led data acquisition, analysis, and interpretation; and drafted the initial manuscript; Ms Moreno made substantial contributions to the acquisition and analysis of data and reviewed and revised the manuscript; Drs Shekelle and Chung made substantial contributions to the study conception and design and acquisition and interpretation of data and reviewed and revised the manuscript; Dr Schuster made substantial contributions to the study conception and design and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted.www.pediatrics.org/cgi

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“…The utility and viability of wellchild care in its present form has been called increasingly into question. 3 We need new ideas to create bigger positive change especially for the health and well being of low income children. The goal of this article is to call on present and future practicing and academic pediatricians to take on the challenge of innovation and change.…”

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Two-Generation Pediatric Care: A Modest Proposal

Zuckerman

2016

Pediatrics

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To reduce inequities in child health, we need to reduce the gap between what we know and what we do. We must challenge our practices and traditions, develop new solutions and have the strength and courage to change how we practice. Based on my experience that the best way to help children is to help their parents, and the best way to reach parents is through their children, I propose a new frame of a 2-generation approach that focuses not only on the child but also on the parents and their relationship to guide our innovation and target improvements. Pediatricians' knowledge and empathy for families is a special base to use new strategies to test ideas on a small number of families with minimal time and cost. Examples from our work includes the following: (1) identify and refer parents with mental health conditions and lack of effective contraception, (2) develop more effective approaches to explain illness and disease to parents, and (3) educate parents about the impact of social relations from infancy on; love can amplify and stress can impair brain and child development. I encourage clinicians to think about what should be changed and more importantly to be excited and brave enough to take the first steps to design and test an idea.

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Does Well-Child Care Have a Future in Pediatrics?

Cited by 50 publications

References 90 publications

A Parent Coach Model for Well-Child Care Among Low-Income Children: A Randomized Controlled Trial

A Parent Coach Model for Well-Child Care Among Low-Income Children: A Randomized Controlled Trial

Well-Child Care Clinical Practice Redesign for Serving Low-Income Children

Two-Generation Pediatric Care: A Modest Proposal

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