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Well-child visits need improvement, say UCLA pediatricians

Several recent studies, however, have reported that the current system of well-child care is suboptimal
Several recent studies, however, have reported that the current system of well-child care is suboptimal
Robin Wulffson, MD

With the goal of delivering preventive pediatric care to low-income families, UCLA researchers conducted a study to determine more efficient methods for delivering preventive care. The findings were published online June 16 in the journal Pediatrics.

The study authors note that well-child visits are the basis of pediatric primary care in the US. These visits account for more than one-third of all outpatient visits for infants and toddlers; they are intended to give doctors the opportunity to identify health, social, developmental, and behavioral issues that could have a long-term effect on children’s lives. Several recent studies, however, have reported that the current system of well-child care is suboptimal. A major concern is that well-child care guidelines issued by the American Academy of Pediatrics recommend that physicians should provide more services than can realistically be accomplished within a 15-minute office visit. As a result, many children do not get all of the preventive care services that they need; in addition, this problem is greater for low-income families, primarily due to their greater psychosocial and developmental needs as well as for and greater need for parenting education.

The year-long study was led by Dr. Tumaini Coker, an assistant professor of pediatrics at Mattel Children’s Hospital UCLA. She and her research team developed a new design for preventive healthcare for children from birth through age three who resided in low-income communities. The investigators joined forces with two community pediatric practices and a multi-site community health center in greater Los Angeles. “The usual way of providing preventive care to young children is just not meeting the needs of the low-income families served by these clinics and practices,” explained Dr. Coker, who also is a researcher with the hospital’s UCLA Children’s Discovery and Innovation Institute. She added, “Our goal was to create an innovative and reproducible, but locally customizable, approach to deliver comprehensive preventive care that is more family-centered, effective and efficient.”

In order to design new models of care, the investigators developed two working groups of pediatric clinicians, staff, clinic leadership, and parents. One working group was located at South Bay Family Health Care, and another working group combined the work of two pediatric practices, the Yovana Bruno Pediatric Clinic in Duarte, California, and Wee Care Associates (led by Dr. Toni Johnson-Chavis), in Compton and Norwalk, California.

The researchers derived input from two sources to develop the new models of care. First, they sought new concepts from pediatricians, parents, and health plan representatives regarding topics such as having non-physicians provide routine preventive care and using “alternative visit formats” such as meeting with healthcare providers in alternative locations, meeting in groups as opposed to one-on-one, or obtaining providers’ advice electronically instead of in person. Secondly, the research teams surveyed existing literature on alternative providers, locations, and formats for well-child care.

Using the aforementioned input, the clinic working groups developed four possible new models of care, which it submitted for review by a panel of experts on preventive care practice redesign. Based on the panel’s rankings, the working groups selected two models to implement and test, one for the private practices and the other for the community clinic. The private practices used a one-on-one visit format, and the community clinic used a group-visit format; however, the two models had several similar features: (1) A trained health educator, or “parent coach,” at each facility who relieved the physician of some of the more routine services and provided preventive health education and guidance, parenting education, and comprehensive but efficient preventive health services related to development, behavior and family psychosocial concerns; (2) A considerably longer preventive care visit; (3) A website that enabled parents to customize their child’s specific needs prior to their visit; and (4) Scheduled text messages or phone calls enabling the healthcare team to communicate with parents.

Now that the initial project has been completed, the researchers have initiated the next stage of the research. They have begun testing the model selected by the two private practices in those clinical settings, with families randomly chosen to receive pediatric care using either the new delivery model and or the old one. The investigators will compare outcomes for the two groups of children by the end of 2014. The community clinic has already implemented its selected model, and testing will begin there in July. Dr. Coker explained, “For clinics and practices that provide child preventive healthcare to families living in low-income communities, the process we used to develop the new models, or the new models themselves, could help them bring innovation to their own practices.”

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