Primary care, as currently designed, is not meeting the needs of children in low-income communities. New structures and process of care have the potential to enhance the receipt of high quality care, and improve outcomes in child health and well-being.
Structural changes may include utilizing non-physician staff to provide health services, using electronic formats for health assessments and other health services, and creating new and innovative process of care.
Current projects include:
Well-Child Care Clinical Practice Redesign: A Parent Coach-Led Model of Care for Young Children
Funder: National Institutes of Health
Principal Investigator: Peter Szilagyi, MD, MPH; Tumaini R. Coker, MD, MBA, PI
Years: 2016-2021 2017-2022
Well-Child Care (WCC) visits for child preventive health care during the first three years of life are critical because they may be the only opportunity before a child reaches preschool to identify and address important social, developmental, behavioral, and health issues that could have significant impact and long-lasting effects on children’s lives as adults. Unfortunately, this opportunity is often missed for children in low-income communities. We used a rigorous, structured community-partnered approach to develop a new, innovative model of WCC delivery to meet the needs of children in low-income communities.
Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT)
PARENT is a team-based approach to care that relies on a health educator (“Parent Coach”) to provide the bulk of WCC services, address specific needs faced by families in low-income communities, and decrease reliance on the clinician as the primary provider of WCC services.
In an initial pilot randomized controlled trial of PARENT among 251 low-income families in two urban area pediatric practices, we found strong and consistent intervention effects on the quality of preventive care provided to families, and on reducing emergency department (ED) utilization. A larger trial of PARENT with multiple clinics is needed to position PARENT as an evidence-based, financially sustainable model for WCC delivery that can be implemented by practices and clinics nationwide.
In this current study, we propose to will conduct a large, multi-site trial of PARENT to: