Well-Child Care Practice Redesign for Low-Income Children: The Perspectives of Health Plans, Medical Groups, and State Agencies

Coker, Tumaini R.; DuPlessis, Helen; Davoudpour, Ramona; Moreno, Candice; Rodríguez, Michael

doi:10.1016/j.acap.2011.08.003

Cited by 18 publications

(14 citation statements)

References 39 publications

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“…Furthermore, some states require Medicaid and Children' s Health Insurance Program-contracted plans to report on a set of quality measures that reward the number of face-to-face well-child visits and inadvertently discourage the use of non-face-to-face strategies. 83 There are promising tools and strategies for WCC clinical practice redesign that may be ready for larger-scale trials. Future directions for research include reporting intervention costs and potential cost savings and a commonly defined set of child and parent outcomes to help researchers build capacity for comparative studies across interventions.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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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:

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Section: Discussionmentioning

confidence: 99%

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

et al. 2013

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“…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.…”

Section: Model 4: Technology-based Modelmentioning

confidence: 99%

“…(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.…”

Section: Cab Meetings: 2 Working Groupsmentioning

confidence: 99%

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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“…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.…”

Section: Intervention Developmentmentioning

confidence: 99%

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

et al. 2016

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OBJECTIVE: The goal of this study was to examine the effects of a new model for well-child care (WCC), the Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT), on WCC quality and health care utilization among low-income families. METHODS:PARENT includes 4 elements designed by using a stakeholder-engaged process:(1) a parent coach (ie, health educator) to provide anticipatory guidance, psychosocial screening and referral, and developmental/behavioral guidance and screening at each wellvisit; (2) a Web-based tool for previsit screening; (3) an automated text message service to provide periodic, age-specific health messages to families; and (4) a brief, problem-focused encounter with the pediatric clinician. The Promoting Healthy Development Survey-PLUS was used to assess receipt of recommended WCC services at 12 months' postenrollment. Intervention effects were examined by using bivariate analyses. RESULTS:A total of 251 parents with a child aged ≤12 months were randomized to receive either the control (usual WCC) or the intervention (PARENT); 90% completed the 12-month assessment. Mean child age at enrollment was 4.5 months; 64% had an annual household income less than $20 000. Baseline characteristics for the intervention and control groups were similar. Intervention parents scored higher on all preventive care measures (anticipatory guidance, health information, psychosocial assessment, developmental screening, and parental developmental/behavioral concerns addressed) and experiences of care measures (family-centeredness, helpfulness, and overall rating of care). Fiftytwo percent fewer intervention children had ≥2 emergency department visits over the 12-month period. There were no significant differences in WCC or sick visits/urgent care utilization. CONCLUSIONS:A parent coach-led model for WCC may improve the receipt of comprehensive WCC for low-income families, and it may potentially lead to cost savings by reducing emergency department utilization.

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Well-Child Care Practice Redesign for Low-Income Children: The Perspectives of Health Plans, Medical Groups, and State Agencies

Cited by 18 publications

References 39 publications

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

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

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

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

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