A novel triage approach of child preventive health assessment: an observational study of routine registry-data

Abstract

BackgroundThe coverage of preventive health assessments for children is pivotal to the system of preventive health screening. A novel method of triage was introduced in the Preventive Youth Health Care (PYHC) system in the Netherlands with an associated shift of tasks of professionals. Doctor’s assistants carried out pre-assessments to identify children in need of follow-up assessment, whereas in the traditional approach all children would have been screened by a doctor or nurse. The accessibility and care delivery of this new PYHC system was studied.MethodsThe new triage approach was compared to the traditional approach in 780 children undergoing PYHC assessment with the use of an observational retrospective study design. Outcomes were attendance of assessment appointments (accessibility of care) and referral of children to either extra PYHC assessment or external specialised care (delivery of preventive care). PYHC registry data were analysed. In two regions of the Netherlands, 390 children five to six years of age were randomly selected from the PYHC registries according to the socio-economic strata of the schools they attended.ResultsWhen the triage and traditional approaches to PYHC were compared, we found similar attendance rates for assessment appointments, namely about 90%. As expected, 100% of the children in the traditional group were assessed by a PYHC doctor compared to 46% of the children in the triage group. Significantly fewer children were referred for extra PYHC assessment or for treatment by an external specialised care giver when a triage as opposed to the traditional assessment approach was used (19.6% vs. 45.9%).ConclusionsThe novel triage approach for preventive health assessment shows equal accessibility, but a different delivery of preventive care. A beneficial effect of the adoption of the triage approach is the opportunity to provide more attention from doctors and nurses to children at risk of health problems. However, lower referral rates of the triage approach may be explained by an under-identification of children with health problems. Further research is needed to document the health outcomes and the possible reduction of health care costs with a triage approach compared to traditional PYHC care.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-014-0498-0) contains supplementary material, which is available to authorized users.

Triage in preventive child healthcare: a prospective cohort study of care use and referral rates for children at risk

“…19 This has been confirmed in our study looking at referral to external services. Our results relating to referral rates to additional PCH assessments associated with the shifting of tasks from PCH physicians and nurses to PCH assistants for the age group of 10 to 11 years are in line with studies of task shifting in primary care, which found more additional assessments when nurses took over tasks from physicians, even though the number of referrals did not change.…”

“…19 In the triage approach, children are pre-assessed by a PCH assistant using a strict protocol which includes the completion of questionnaires by parents and teachers, and face-to-face screening (that covers areas such as growth, hearing and vision). Only children with suspected health concerns are selected by the PCH assistant for follow-up assessment by a PCH physician or nurse.…”

“…We found that attendance levels were the same, and that the referral rate to additional PCH assessments or external services was lower, in the triage approach than in the usual approach. 19 Another study showed that routine assessments in a triage approach detect health concerns as effectively as the usual approach. 20 Our study of the costs of the routine assessments in the two approaches showed that the triage approach resulted in a cost reduction of about one-third for the age group of 5 to 6 years and a minimal cost reduction for the age group of 10 to 11 years.…”

A Novel Triage Approach to Identifying Health Concerns

“…16 Triage preassessments are conducted in the absence of parents, whereas the traditional health assessments are conducted with parents present. Literature claims that the early detection of health problems is more accurate when parents are present, 23,25 but this study did not find a difference in identification rates between the 2 approaches.…”

“…A pilot study of the triage approach 16 found no change in accessibility of PCH, but significantly fewer children were referred for extra PCH assessment or for treatment by an external specialist than in a traditional approach. Further research was needed to compare the quality of care delivered by the triage approach to traditional PCH.…”