A Novel Triage Approach to Identifying Health Concerns

Bezem, Janine; Theunissen, M.H.C.; Kamphuis, M.; Numans, Mattijs E.; Buitendijk, S. E.; Kocken, P.L.

doi:10.1542/peds.2015-0814

Cited by 9 publications

(11 citation statements)

References 21 publications

(26 reference statements)

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“…To study the costs of routine health assessments we used data from a larger study of the effects of the triage approach which was performed in two PCH services using the triage approach and two PCH services with similar demographic characteristics which used the usual approach [ 16 ]. Each PCH service covers a population of around 125,000 children annually aged between 0 and 18 years.…”

Section: Methodsmentioning

confidence: 99%

“…To compare the costs of the triage and usual approach, we calculated the projected costs for a theoretical cohort of 100,000 children. Attendance rates for the pre-assessments and follow-up assessments and the referral rate to follow-up assessments in the triage approach—and the attendance and referral rates for assessments in the usual approach—(see Figs 1 and 2 ) were measured as part of the larger study of the effects of the triage approach using a study cohort of 1897 children [ 16 ]. We used these rates to determine the numbers of the different types of assessments needed for a theoretical cohort of 100,000 children.…”

Section: Methodsmentioning

confidence: 99%

“…Significantly fewer children were referred for additional assessment by PCH or for treatment to external health services in the triage approach [ 15 ]. Further research is needed to compare the efficiency of care delivered by the triage approach with usual practice [ 16 ]. The aim of this study was to compare the costs of conducting preventive child health assessments with a triage approach and the usual approach.…”

Section: Introductionmentioning

confidence: 99%

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Preventive child health care at elementary school age: The costs of routine assessments with a triage approach

et al. 2017

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BackgroundTriage in Preventive Child Health Care (PCH) assessments could further the efficient use of human resources and budgets and therefore make extra care possible for children with specific needs. We assessed the costs of routine PCH assessments with and without triage for children aged 5/6 years and 10/11 years. In a triage approach, PCH assistants conduct pre-assessments to identify children requiring follow-up assessments by a physician or nurse. In the usual approach, all children are assessed by a physician and an assistant (children aged 5/6 years) or a nurse (children aged 10/11 years).MethodsAll the direct costs of conducting routine PCH assessments with the triage and usual approach were assessed using a bottom-up micro-costing approach. In four PCH services in the Netherlands, two using triage and two the usual approach, professionals completed questionnaires about time spent on assessments, including time related to non-attendance at assessments, the referral of children and administration.ResultsThe projected costs for PCH professionals working on PCH assessments amounted to €5.2 million per cohort of 100,000 children aged 5/6 years in the triage approach, and €7.6 million in the usual approach. The projected costs in both approaches for children aged 10/11 years were about €4 million per 100,000 children.ConclusionThe triage approach to PCH resulted in a projected cost reduction of about one-third, compared with usual practice, for routine assessments by physicians of children aged 5/6 years. There are minimal cost savings in the group of children aged 10/11 years when nurses are involved and so other considerations such as workforce shortages would be required to justify a change to a triage approach. Further research is needed to investigate the differences in costs of care after the completion of the routine assessments.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Preventive child health care at elementary school age: The costs of routine assessments with a triage approach

et al. 2017

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“…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. 21 This study examined the impact of triage and task shifting on care for children at risk who were identified by PCH or by external parties such as parents and schools.…”

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confidence: 82%

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

et al. 2017

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ObjectivesA novel triage approach to routine assessments was introduced to improve the efficiency of Preventive Child Healthcare (PCH): PCH assistants carried out pre-assessments of all children and sent the children with suspected health problems to follow-up assessments conducted by a physician or nurse. This two-step approach differed from the usual approach, in which physicians or nurses assessed all children. This study was aimed to examine the impact of triage and task shifting on care for children at risk identified by PCH or parents and schools.Design and participantsAn observational prospective cohort design was used, with an analysis of the basic registration data from the preventive health assessments for 1897 children aged 5 to 6, and 10 to 11, years from a sample of 41 schools stratified by socioeconomic status, region of PCH service and urbanisation.SettingA comparison was made between two PCH services in the Netherlands that used the triage approach and two PCH services that provided the usual approach.Main outcome measuresThe primary outcome measures were the referral rates to either additional PCH assessments or external services. The secondary outcome measures were the rates of PCH assessments requested by, for example, parents and schools.ResultsOverall, a higher referral rate to additional PCH assessments was found for the triage approach than for the usual approach (OR 1.3, 95% CI 1.0 to 1.6), mainly in the age group of 5 to 6 years (OR 1.9, 95% CI 1.3 to 2.7). We found a lower rate of referral to external services in the triage approach (OR 0.4, 95% CI 0.3 to 0.7) and a higher referral rate to PCH assessments on request (OR=4.6, 95% CI 3.0 to 7.0).ConclusionsThe triage approach provides extra opportunities to deliver PCH assessments and PCH assessments on request for children at risk. Further research is needed into the cost benefits of the triage approach.

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“…The diagnostic accuracy of blood pressure measurements among asymptomatic children and the benefits and harm of screening for adolescent idiopathic scoliosis are unclear [ 11 – 13 ]. In the Netherlands, no significant differences were found in the detection of children’s overweight, visual disorders or psychosocial problems between doctors’ assistants, nurses, and doctors [ 14 ]. A German study suggested that health checks by physicians at school entry could be reduced by targeting them at children who are at risk of a severe developmental disorder [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Associations between study questionnaire-assessed need and school doctor-evaluated benefit of routine health checks: an observational study

et al. 2021

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Background In Finland, school doctors examine all children at predetermined ages in addition to annual health checks by school nurses. This study explored the association of study questionnaire-assessed need for and school doctor-evaluated benefit of routine health checks conducted by doctors. Methods Between August 2017 and August 2018, we recruited a random sample of 1341 children in grades 1 and 5 (aged seven and eleven years, respectively) from 21 elementary schools in four Finnish municipalities. Children mainly studying in special education groups or whose parents needed an interpreter were excluded. School nurses performed their health check as usual. Parents, nurses, and teachers then completed study questionnaires that assessed the concerns of parents, school nurses, and teachers regarding each child’s physical, mental and social health. Doctors, blinded to the responses, routinely examined all the children. The primary outcome measures were (1) the need for a health check based on the study questionnaires and (2) the benefit/harm of the appointment as estimated by the doctors according to predetermined criteria, and (3) the patient-reported experience measures (PREMs) of benefit/harm of the appointment as estimated by the parents and children. We compared the need for a health check with the doctor-evaluated benefit using multilevel logistic regression. Results The participation rate was 75.5 %. According to all questionnaires, 20–25 % of the 1013 children had no need for a health check. The doctors regarded 410 (40.6 %) and the parents 812 (83.4 %) of the appointments as being beneficial. Respondents rarely reported harm. The children who were classified as needing a health check more often benefitted from the health check (assessed by the doctor) than children with no need for one (OR 3.53; 95 % CI 2.41–5.17). Conclusions The need for a health check is an important predictor of school-doctor evaluated benefit of the health check. This approach could allow school doctors to allocate time for the children who need them most. Trial registration ClinicalTrials.gov, Identifier NCT03178331, registration June 6th 2017.

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A Novel Triage Approach to Identifying Health Concerns

Cited by 9 publications

References 21 publications

Preventive child health care at elementary school age: The costs of routine assessments with a triage approach

Preventive child health care at elementary school age: The costs of routine assessments with a triage approach

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

Associations between study questionnaire-assessed need and school doctor-evaluated benefit of routine health checks: an observational study

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