No abstract

Objective To compare preventive care quality for children at risk and not at risk for developmental, behavioral, or social delays. Methods Using the 2007 National Survey of Children’s Health (n = 22,269), we used the Parents’ Evaluation of Developmental Status (PEDS) questionnaire to identify children ages 10 months to 5 years who were at risk for delays. We examined parent-reported quality measures to evaluate whether care was comprehensive, coordinated, family-centered, effective in providing developmental surveillance and screening, and provided within a medical home. Bivariate and multivariate analyses were used. Results Twenty-eight percent of children were at-risk for delay, with 17% at moderate risk and 11% at high risk. Greater proportions of children at high, moderate, and no/low risk had a usual source of care (89%–96%) and a personal doctor/nurse (91%–94%); smaller proportions of children underwent a standardized developmental screening (16%–23%) and had parental developmental concerns elicited from their doctor (47%–48%). In adjusted analyses, moderate-risk and high-risk children were less likely than no/low-risk children to receive needed care coordination (adjusted odds ratio [AOR] for high risk 0.33, 95% confidence interval [95% CI] 0.24–0.46) and referrals (high risk AOR 0.40, 95% CI 0.25–0.65), family-centered care (high-risk AOR 0.47, 95% CI 0.36–0.62), and to have a medical home (high-risk AOR 0.41, 95% CI 0.32–0.54). Conclusions Our findings may reflect either poorer quality of care provided to at-risk children, or higher level of parental need that routine visits are not currently meeting. For at-risk children, enhanced screening and detection followed by targeted increases in communication and follow-up may help clinicians better anticipate families’ needs.

No abstract

Several forces will progressively change the current US healthcare system. First, patient factors will likely exert the greatest impact. The rapidly growing US population, a growing percentage of seniors, increasing prevalence of chronic disease, increasing racial/ethnic diversity and persisting healthcare disparities will strain an already overloaded system. Second, healthcare system factors are also contributing to challenges. Shortages in the healthcare workforce, the rising costs, complexity and chronicity of care, the burdens of caregivers as primary health providers, the failure to address social determinants of health and the emergence of retail healthcare will exacerbate that strain. This chapter discusses implications of these forces in the context of health information systems evolving to meet these healthcare challenges. We conclude with a case study of a potential future patient-centered health information system and a discussion of patient-oriented features of effective health information systems.