2020 Recommendations for Preventive Pediatric Health Care

Richerson, Julia E.; Abularrage, Joseph J.; Almendarez, Yvette M.; Boudreau, Alexy D. Arauz; Berhane, Abeba M.; Cantrell, Patricia E.; Hackell, Jesse M.; Kafer, Lisa M.; Warner, Robin; Hagan, Joseph F.; Kemper, Alex R.; Shaw, Judith S.

doi:10.1542/peds.2020-0013

Cited by 14 publications

(5 citation statements)

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“…One item from the Consumer Assessment of Healthcare Providers and Systems was used as a global measure for the overall rating of care. To define up-to-date well-child care, the American Academy of Pediatrics Periodicity Schedule was used. All visits between enrollment and 12-month follow-up were considered in this study.…”

Section: Methodsmentioning

confidence: 99%

Community Health Workers in Early Childhood Well-Child Care for Medicaid-Insured Children

Coker

Liljenquist

Lowry

et al. 2023

JAMA

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ImportanceAn intervention model (the Parent-focused Redesign for Encounters, Newborns to Toddlers; the PARENT intervention) for well-child care that integrates a community health worker into preventive care services may enhance early childhood well-child care.ObjectiveTo examine the effectiveness of the PARENT intervention vs usual care for parents with children younger than 2 years of age.Design, Setting, and ParticipantsA cluster randomized clinical trial was conducted between March 2019 and July 2022. Of the 1283 parents with a child younger than 2 years of age presenting for a well-child visit at 1 of the 10 clinic sites (2 federally qualified health centers in California and Washington) approached for trial participation, 937 were enrolled.InterventionFive clinics implemented the PARENT intervention, which is a team-based approach to care that uses a community health worker in the role of a coach (ie, health educator) as part of the well-child care team to provide comprehensive preventive services, and 5 clinics provided usual care.Main Outcomes and MeasuresThere were 2 primary outcomes: score for parent-reported receipt of recommended anticipatory guidance during well-child visits (score range, 0-100) and emergency department (ED) use (proportion with ≥2 ED visits). The secondary outcomes included psychosocial screening, developmental screening, health care use, and parent-reported experiences of care.ResultsOf the 937 parents who were enrolled, 914 remained eligible to participate (n = 438 in the intervention group and n = 476 in the usual care group; 95% were mothers, 73% reported Latino ethnicity, and 63% reported an annual income &lt;$30 000). The majority (855/914; 94%) of the children (mean age, 4.4 months at parental enrollment) were insured by Medicaid. Of the 914 parents who remained eligible and enrolled, 785 (86%) completed the 12-month follow-up interview. Parents of children treated at the intervention clinics (n = 375) reported receiving more anticipatory guidance than the parents of children treated at the usual care clinics (n = 407) (mean score, 73.9 [SD, 23.4] vs 63.3 [SD, 27.8], respectively; adjusted absolute difference, 11.01 [95% CI, 6.44 to 15.59]). There was no difference in ED use (proportion with ≥2 ED visits) between the intervention group (n = 376) and the usual care group (n = 407) (37.2% vs 36.1%, respectively; adjusted absolute difference, 1.2% [95% CI, −5.5% to 8.0%]). The effects of the intervention on the secondary outcomes included a higher amount of psychosocial assessments performed, a greater number of parents who had developmental or behavioral concerns elicited and addressed, increased attendance at well-child visits, and greater parental experiences with the care received (helpfulness of care).Conclusions and RelevanceThe intervention resulted in improvements in the receipt of preventive care services vs usual care for children insured by Medicaid by incorporating community health workers in a team-based approach to early childhood well-child care.Trial RegistrationClinicalTrials.gov Identifier: NCT03797898

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Section: Methodsmentioning

confidence: 99%

Community Health Workers in Early Childhood Well-Child Care for Medicaid-Insured Children

Coker

Liljenquist

Lowry

et al. 2023

JAMA

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“…We focused on 2 outcomes: the proportion of children who had an office or outpatient visit without a wellness visit and the proportion of wellness visits resulting in an out-of-pocket cost, which were calculated annually during the study period. We stratified the sample by 2 age groups (0 to 5 years and 6 to 17 years) because these groups have a different recommended frequency of visits for wellness and other preventive services . Diagnosis codes from the International Classification of Diseases, Ninth Revision (visits before October 2015) and International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (visits in October 2015 and after) and Current Procedural Terminology and Healthcare Common Procedure Coding System codes used to identify preventive services were obtained from the Centers for Disease Control and Prevention and were supplemented with coding guidelines from major insurers…”

Section: Methodsmentioning

confidence: 99%

Trends in Well-Child Visits With Out-of-Pocket Costs in the US Before and After the Affordable Care Act

2021

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“…A total of 9 sources of current clinical practice guidelines were reviewed, and the recommendations from the 4 sources with relevant recommendations as of October 31, 2020 are summarized in Table 1 . 13 , 14 , 15 , 16 , 17 , 18 , 19 Across the 9 sources, the following services related to prevention for children's mental health were recommended: anticipatory guidance to caregivers and children on promoting family mental health 13 , 14 ; psychosocial interventions to prevent postpartum depression 16 ; assessment of behavioral health and social needs for caregivers and connection to providers, programs, and community-based resources that can meet those needs 13 , 14 , 18 , 19 ; and assessment of developing psychosocial needs in children and provision of services to address those needs—including before they rise to the level of a diagnosable condition. 13 , 14 , 15 , 17 …”

Section: Requirements Of Existing Federal Health Policymentioning

confidence: 99%

Enforcing Legal Compliance for Covering of Services Promoting Family Mental Health

Counts

Walker-Harding

Miller

2022

American Journal of Preventive Medicine

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2020 Recommendations for Preventive Pediatric Health Care

Cited by 14 publications

References 1 publication

Community Health Workers in Early Childhood Well-Child Care for Medicaid-Insured Children

Community Health Workers in Early Childhood Well-Child Care for Medicaid-Insured Children

Trends in Well-Child Visits With Out-of-Pocket Costs in the US Before and After the Affordable Care Act

Enforcing Legal Compliance for Covering of Services Promoting Family Mental Health

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