Rethinking Well-Child Care in the United States: An International Comparison

Kuo, Alice; Inkelas, Moira; Lotstein, Debra; Samson, Kyra M.; Schor, Edward L.; Halfon, Neal

doi:10.1542/peds.2006-0620

Cited by 114 publications

(123 citation statements)

References 10 publications

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“…16,[18][19][20] With the advent of retail-based clinics and Internet-based care, 35 a greater burden of chronic disease during childhood, 36 and an increasing need for chronic care management, 37 primary care pediatrics may need to adapt to a more specialty-based model similar to primary care pediatrics in many other developed nations. 38,39 This study has several limitations. First, WCC models were designed specifically for practices involved in the study and may not be generalizable to others.…”

Section: Model 4: Technology-based Modelmentioning

confidence: 95%

Well-Child Care Clinical Practice Redesign for Serving Low-Income Children

et al. 2014

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Our objective was to conduct a rigorous, structured process to create a new model of well-child care (WCC) in collaboration with a multisite community health center and 2 small, independent practices serving predominantly Medicaid-insured children. Working groups of clinicians, staff, and parents (called "Community Advisory Boards" [CABs]) used (1) perspectives of WCC stakeholders and (2) a literature review of WCC practice redesign to create 4 comprehensive WCC models for children ages 0 to 3 years. An expert panel, following a modified version of the Rand/UCLA Appropriateness Method, rated each model for potential effectiveness on 4 domains: (1) receipt of recommended services, (2) family-centeredness, (3) timely and appropriate followup, and (4) feasibility and efficiency. Results were provided to the CABs for selection of a final model to implement. The newly developed models rely heavily on a health educator for anticipatory guidance and developmental, behavioral, and psychosocial surveillance and screening. Each model allots a small amount of time with the pediatrician to perform a brief physical examination and to address parents' physical health concerns. A secure Web-based tool customizes the visit to parents' needs and facilitates previsit screening. Scheduled, non-face-to-face methods (text, phone) for parent communication with the health care team are also critical to these new models of care. A structured process that engages small community practices and community health centers in clinical practice redesign can produce comprehensive, site-specific, and innovative models for delivery of WCC. This process, as well as the models developed, may be applicable to other small practices and clinics interested in practice redesign. Pediatrics 2014;134:e229-e239 Dr Coker conceptualized and designed the study; led data acquisition, analysis, and interpretation; and drafted the initial manuscript; Ms Moreno made substantial contributions to the acquisition and analysis of data and reviewed and revised the manuscript; Drs Shekelle and Chung made substantial contributions to the study conception and design and acquisition and interpretation of data and reviewed and revised the manuscript; Dr Schuster made substantial contributions to the study conception and design and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted.www.pediatrics.org/cgi

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Section: Model 4: Technology-based Modelmentioning

confidence: 95%

Well-Child Care Clinical Practice Redesign for Serving Low-Income Children

et al. 2014

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“…1,2 Sufficient evidence exists that screening for amblyopia, monitoring of psychosocial problems and growth in children of elementary school age, enhance health and social well-being. [3][4][5][6][7] However, awareness is growing that preventive services for children must be conducted more cost-efficiently and in better alignment with current health system issues, such as improved use of physician and nurse competence, evolving health priorities, inequities in health, and uneven access to preventive care.…”

Section: What This Study Addsmentioning

confidence: 99%

A Novel Triage Approach to Identifying Health Concerns

et al. 2016

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“…[1][2][3][4][5][6][7][8] In the past decade, numerous studies have addressed the growing number of anticipatory guidance topics, 9 disparities in access, 10,11 and discrepancies in quality. 2,[12][13][14] The new Bright Futures guidelines 15 provide the pathway for many advancements, but as the history of well-child care shows, pediatrics will continue to strive for additional improvement.…”

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confidence: 99%

What Do Families Want From Well-Child Care? Including Parents in the Rethinking Discussion

et al. 2009

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WHAT'S KNOWN ON THIS SUBJECT:Schor called on pediatricians to rethink well-child care. Gaps exist between traditional wellchild care and contemporary needs and pressures. A key, but largely missing, perspective in the rethinking of discussions has been that of parents. WHAT THIS STUDY ADDS:In this qualitative study, we asked parents to address several core issues including why they attend well-child care visits, the aspects of care they find most valuable, and what changes could enhance the well-child experience.abstract OBJECTIVE: The content and systems surrounding well-child care have received increasing attention, and some propose that it is time to rethink both the delivery structure and central themes of well-child visits. A key, but largely missing perspective in these discussions has been that of parents, whose experiences and expectations are central to developing approaches responsive to family needs. In this study, we asked parents to address several core issues: why they attend wellchild visits; aspects of well-child care that they find most valuable; and changes that could enhance the well-child care experience. METHODS: Twenty focus groups with parents (n ϭ 131 [91% mothers])were conducted by using a semistructured interview guide. Verbatim transcripts were coded for key words, concepts, and recurrent themes. RESULTS:Primary reasons for visit attendance included reassurance (child and parent) and an opportunity to discuss parent priorities. Families valued an ongoing relationship with 1 clinician who was childfocused and respected parental expertise, but continuity of provider was not an option for all participants. Suggestions for enhancement included improved promotion of well-child care, greater emphasis on development and behavior, and expanded options for information exchange. CONCLUSIONS:As the consumers of care, it is critical to understand parents' needs and desires as changes to the content and process of well-child care are considered. Taking into account the multifaceted perspectives of families suggests both challenges and opportunities for the rethinking discussion. Pediatrics 2009;124:858-865

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Rethinking Well-Child Care in the United States: An International Comparison

Cited by 114 publications

References 10 publications

Well-Child Care Clinical Practice Redesign for Serving Low-Income Children

Well-Child Care Clinical Practice Redesign for Serving Low-Income Children

A Novel Triage Approach to Identifying Health Concerns

What Do Families Want From Well-Child Care? Including Parents in the Rethinking Discussion

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