Well-Child Care Clinical Practice Redesign at a Community Health Center

Abstract

Background Community health centers (CHCs) are a key element of the health care safety net for underserved children. They may be an ideal setting to create well-child care (WCC) clinical practice redesign to drastically improve WCC delivery. Objective To examine the perspectives of clinical and administrative staff at a large, multisite urban CHC on alternative ways to deliver WCC services for low-income children aged 0 to 3 years. Methods Eight semistructured interviews were conducted with 4 pediatric teams (each consisting of 1 pediatrician and 2 medical assistants) and 4 CHC executive/administrative staff (Medical Director, COO, CEO, and Nurse Supervisor). Discussions were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis. Salient themes included WCC delivery challenges and endorsed WCC clinical practice redesign solutions. Results The 3 main WCC delivery challenges included long wait times due to insurance verification and intake paperwork, lack of time for parent education and sick visits due to WCC visit volume, and absence of a system to encourage physicians to use non–face-to-face communication with parents. To address WCC delivery challenges, CHC providers and administrators endorsed several options for clinical practice redesign in their setting. These included use of a health educator in a team-based model of care, a previsit tool for screening and surveillance, Web site health education, a structured system for non–face-to-face (eg, phone) parent communication, and group visits. Conclusion CHC-specific strategies for WCC clinical practice redesign endorsed by a large, multisite safety net clinic may lead to more efficient, effective, and family-centered WCC for low-income populations.

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

“…19,34 Our findings from previous WCC redesign studies suggest that a WCC model that is less reliant on the physician for routine WCC services is acceptable to parents, payers, and pediatricians. 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.…”

“…13 Additionally, community health centers (CHCs) are a critical source of primary care for children in low-income communities. 14,15 These practices and clinics report major barriers to effective WCC 16 and will need explicit processes for selecting and implementing innovative delivery models in ways that are feasible and customized for their families. One such explicit process is a community-based adaptation of the modified Delphi method known as the Rand/UCLA Appropriateness Method (RAM).…”

Perception, attitude, and satisfaction of paediatric physicians and nurses towards clinical practice guidelines at a university teaching hospital

“…One of the strengths of our study was that it included both physicians and nurses in its sample to explore similarities and differences in their perception, attitude, and satisfaction towards CPGs with concentration on the DKA‐CPG project. Similar studies selected their target sample as physicians only, missing the significant contribution and feedback of a keystone team member of any successful health care improvement project: the nurse …”

“…The target sample included both physicians and nurses as both categories of health care providers complement each other in a unified multidisciplinary team model during all of the stages of delivery of paediatric health care and they share the main medical encounter with the patients . The role of physicians in the CPGI included the assessment, diagnosis, clinical decision‐making process, and treatment in the form of physician orders (medication prescription) and follow‐up.…”

Social Ecological Factors Associated with Parental Vaccination Decisions and Perceptions of Barriers to Childhood Immunizations

“…A study exploring challenges and design solutions that would apply to well-child care visits (e.g., tailoring of vaccine communication at wellchild care visits) revealed several challenges for well-child care visits. Of particular importance to the topic of vaccine education and communication was the theme of a lack of time for parent education due to the volume of both sick and well child visits (Mooney, Moreno, Chung, Elijah, & Coker, 2014). A redesign solution theme that emerged in this study was using a pre-visit parent preparation tool (Mooney et al, 2014).…”