Rethinking Well-Child Care

Schor, Edward L.

doi:10.1542/peds.114.1.210

Cited by 155 publications

(99 citation statements)

References 20 publications

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“…2 Much of this unmet need stems from a lack of time and resources on the part of the primary care physician (PCP) to deliver the prescribed preventive and developmental services during WCC visits. [3][4][5] Some of these time constraints could be lessened if the PCP was able to collect screening information and parental concerns before the visit. This would allow for the visit to be tailored to the specific needs of the patient and family and would improve the efficiency and effectiveness of the encounter.…”

Section: Introductionmentioning

confidence: 99%

A New Model of Well-Child Care: Implications for Resource Costs and Dissemination

Ritzwoller

Sukhanova²,

Beck³

et al. 2011

TPJ

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Section: Introductionmentioning

confidence: 99%

A New Model of Well-Child Care: Implications for Resource Costs and Dissemination

Ritzwoller

Sukhanova²,

Beck³

et al. 2011

TPJ

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“…Proposals to improve WCC delivery include changes such as utilizing group visits, incorporating nonphysician child developmental specialists into the visit, and instituting standardized screening by nonphysician staff. [8][9][10] Although practice redesign in large, integrated delivery systems has been described, 11,12 smaller practices with #5 physicians provide most primary care. 13 Additionally, community health centers (CHCs) are a critical source of primary care for children in low-income communities.…”

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confidence: 99%

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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“…A review of current literature provided documentation of the changing demographics and disease/disorder patterns among children and adolescents in the United States and the implications for pediatric practice. [4][5][6][7] There is a small but growing body of literature examining educational strategies and assessment measures in medical education. 8-19 R 3 P Project participants also searched for data that have captured the voices of recently trained pediatric generalists and subspecialists and current subspecialty fellows and residents regarding residency choice and career choice, adequacy of pediatric training, and early experiences in practice or as junior faculty.…”

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confidence: 99%

What Can Data Tell Us About the Quality and Relevance of Current Pediatric Residency Education?

Leslie

2009

Pediatrics

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The Residency Review and Redesign (R 3 P) Project relied on both qualitative and quantitative data in developing its recommendations regarding residency education. This article reviews quantitative data in the published literature of import to the R 3 P Project as well as findings by Freed and colleagues published in this supplement to Pediatrics. Primary questions of interest to the R 3 P Project included: What factors drive decision-making regarding residency selection? Do current training programs have the flexibility to meet the needs of residents, no matter what their career choice with pediatrics? What areas need greater focus within residency training? Should the length of training remain at 36 months? Based on the available data, the R 3 P Project concluded that more diversity needs to be fostered with training programs. By promoting innovative and diverse approaches to improving pediatric residency education, members of the R 3 P Project hope to enhance learning, encourage multiple career paths within the broad field of pediatrics, and, ultimately, improve patient and family outcomes. Pediatrics 2009;123:S50-S55 T HREE ARTICLES IN this supplement to Pediatrics detail the proceedings from the Residency Review and Redesign in Pediatrics (R 3 P) Project colloquia. 1-3 These dialogue-driven sessions provided crucial qualitative data relevant to the R 3 P Project. Using strategies commonly applied for strategic planning processes in the business, policy, and technology sectors, participants in the colloquia clarified their values regarding pediatric residency education, their concerns about factors affecting training, and their hopes for solutions. The interplay between participants allowed for greater understanding of different stakeholders' perspectives regarding the developmental and historical processes influencing residency education and appreciation for the myriad social and political factors that contribute to our uncertainty regarding the state of pediatric residency education in the future.Concurrently, participants of the R 3 P Project pursued a variety of sources to identify quantifiable data that would inform its recommendations. A review of current literature provided documentation of the changing demographics and disease/disorder patterns among children and adolescents in the United States and the implications for pediatric practice. [4][5][6][7] There is a small but growing body of literature examining educational strategies and assessment measures in medical education. 8-19 R 3 P Project participants also searched for data that have captured the voices of recently trained pediatric generalists and subspecialists and current subspecialty fellows and residents regarding residency choice and career choice, adequacy of pediatric training, and early experiences in practice or as junior faculty.The picture that emerges from available data is that pediatricians who choose specialty training are more likely to be male, 20 white, 20 and interested in teaching, 21 research, 21,22 and technical ...

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Rethinking Well-Child Care

Cited by 155 publications

References 20 publications

A New Model of Well-Child Care: Implications for Resource Costs and Dissemination

A New Model of Well-Child Care: Implications for Resource Costs and Dissemination

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

What Can Data Tell Us About the Quality and Relevance of Current Pediatric Residency Education?

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