Well-Child Care Clinical Practice Redesign for Young Children: A Systematic Review of Strategies and Tools

Abstract

BACKGROUND AND OBJECTIVE: Various proposals have been made to redesign well-child care (WCC) for young children, yet no peerreviewed publication has examined the evidence for these. The objective of this study was to conduct a systematic review on WCC clinical practice redesign for children aged 0 to 5 years. METHODS:PubMed was searched using criteria to identify relevant English-language articles published from January 1981 through February 2012. Observational studies, controlled trials, and systematic reviews evaluating efficiency and effectiveness of WCC for children aged 0 to 5 were selected. Interventions were organized into 3 categories: providers, formats (how care is provided; eg, non-face-to-face formats), and locations for care. Data were extracted by independent article review, including study quality, of 3 investigators with consensus resolution of discrepancies. RESULTS:Of 275 articles screened, 33 met inclusion criteria. Seventeen articles focused on providers, 13 on formats, 2 on locations, and 1 miscellaneous. We found evidence that WCC provided in groups is at least as effective in providing WCC as 1-on-1 visits. There was limited evidence regarding other formats, although evidence suggested that non-face-to-face formats, particularly web-based tools, could enhance anticipatory guidance and possibly reduce parents' need for clinical contacts for minor concerns between well-child visits. The addition of a non-medical professional trained as a developmental specialist may improve receipt of WCC services and enhance parenting practices. There was insufficient evidence on nonclinical locations for WCC. CONCLUSIONS:

A Parent Coach Model for Well-Child Care Among Low-Income Children: A Randomized Controlled Trial

“…Key stakeholders from the practice sites, including parent representatives, pediatricians, and medical assistants, formed a community advisory board (CAB). Over a series of meetings, the CAB designed the new WCC system by using qualitative data from stakeholder interviews, [19][20][21][22] a systematic literature review, 16 and an expert panel process. 18 The CAB was involved in all aspects of intervention development (including parent coach [PC] curriculum, training, and ongoing education), implementation, and testing, and the CAB continued regular meetings throughout the trial to monitor progress of the intervention.…”

“…1,2,[12][13][14][15] Various tools and strategies to redesign the structure of WCC have been proposed and studied; however, there are few evidencebased comprehensive models of care to serve as feasible and sustainable alternatives to the current WCC structure in most small community practices. 16,17 Our comprehensive model (ie, the Parentfocused Redesign for Encounters, Newborns to Toddlers [PARENT]) was developed to address these key structural deficiencies in our current WCC system by decreasing reliance on the physician for routine WCC and shifting many WCC services to a health educator. 18 Our objective was to test the effectiveness of the PARENT intervention in providing comprehensive, nationally recommended WCC services, while optimizing WCC, urgent care, and emergency department (ED) utilization among low-income families.…”

A Novel Triage Approach to Identifying Health Concerns

“…[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. [8][9][10][11] Many countries have preventive child health care (PCH) programs for universal routine child health assessments, and vaccination programs. The Netherlands has a free PCH program for all children aged 0 to 18 years, including ∼17 routine health assessments.…”

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

“…(henceforth Community Advisory Boards [CABs]) used data from WCC stakeholders, [18][19][20] a systematic literature review, 21 and a WCC framework designed for this study to develop 4 potential models for WCC delivery for children ages 0 to 3 years in low-income communities.…”

“…In our systematic literature review, we found tools and strategies for improving WCC delivery, but few offered a comprehensive model. 21 In 1995, Zuckerman and Parker 25 proposed a comprehensive, communitybased system of pediatric primary care that included collaboration with early childhood educators to enhance developmental and behavioral services and a 2-generational approach that included primary care services to parents and children. Other proposed models have included e-visits and "tailored" well-visits based on the family' s needs.…”