Gaps in Well-Child Care Attendance Among Primary Care Clinics Serving Low-Income Families

Abstract

BACKGROUND AND OBJECTIVES:It is unclear which specific well-child visits (WCVs) are most frequently missed and whether age-specific patterns of attendance differ by race or insurance type. METHODS:We conducted a retrospective cohort study of children 0 to 6 years old between 2011 and 2016 within 2 health networks spanning 20 states. WCVs were identified by using International Classification of Diseases, Ninth and 10th Revisions and Current Procedural Terminology codes. We calculated adherence to the 13 American Academy of Pediatricsrecommended WCVs from birth to age 6 years. To address data completeness, we made 2 adherence calculations after a child's last recorded WCV: 1 in which we assumed all subsequent WCVs were attended outside the network and 1 in which we assumed none were. RESULTS:We included 152 418 children in our analysis. Most children were either publicly insured (77%) or uninsured (14%). The 2-, 4-, and 6-month visits were the most frequently attended (63% [assuming no outside care after the last recorded WCV] to 90% [assuming outside care]), whereas the 15-and 18-months visits (41%-75%) and 4-year visit (19%-49%) were the least frequently attended. Patients who were publicly insured and uninsured (versus privately insured) had higher odds of missing WCVs. Hispanic and Asian American (versus non-Hispanic white) patients had higher odds of attending WCVs. DISCUSSIONThe 15-and 18-month WCVs as well as the 4-year WCV are the least frequently attended WCVs. The former represent opportunities to identify developmental delays, and the latter represents an opportunity to assess school readiness.

Family navigation to increase evaluation for autism spectrum disorder in toddlers: Screening and Linkage to Services for Autism pragmatic randomized trial

“…Study power was also reduced because fewer children presented for well visits at 18 or 24 months of age (when ASD screening was normally provided) than expected based on DH’s patient population. Children from lower-income or less educated households or who have no insurance or public insurance are more likely to miss well-child visits (Selden, 2006; Wolf et al, 2018), contributing to disparities in ASD screening and diagnosis. Families of children who fail to attend well visits may encounter even greater barriers to obtaining EI evaluation and services than children who do attend.…”

Reducing Poverty-Related Disparities in Child Development and School Readiness: The Smart Beginnings Tiered Prevention Strategy that Combines Pediatric Primary Care with Home Visiting

“…Medicaid expansion and the State Children's Health Insurance Program have resulted in ~ 95% of children being covered and ~ 60% of the remainder eligible for public insurance (Cohen et al, 2020;Kenney et al, 2016), in turn facilitating attendance at AAP-recommended visits. Although attendance is significantly lower for families receiving public insurance, visit attendance is still estimated conservatively at 40-80% across all visits through age 3 years (Wolf et al, 2018). Primary care also offers early and frequent contact with families, which translates to a high number of potential "doses" of primary care interventions.…”

Well-Child Care Adherence After Intrauterine Opioid Exposure

“…On the basis of existing literature on WCC use, we assessed clinical and sociodemographic covariates, including child race, ethnicity, sex, insurance type, birth weight, and gestational age. [25][26][27] An indicator variable identifying complex chronic conditions was derived by using a previously established classification system. 28 Given the known association between community-level effects and health care use, patient zip code was linked to US Census Bureau data to derive an area-level measure of the percentage of residents living below the federal poverty level.…”

“…51 Our findings are also consistent with previous research revealing socioeconomic disparities in WCC adherence. 27 Some of the key drivers hypothesized to impact WCC adherence include transportation issues, time constraints, family crisis events, and low perceived value of primary care. 26,52 Mothers with OUD may also encounter challenges such as stigmatization and discrimination, legal and child custody concerns, and mental health issues.…”