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Redesigning the Well-child Checkup

  Well-child Checkup
  Illustration: Maja Moden

Well-child visits are the foundation of pediatric primary care in the U.S., accounting for more than one-third of all outpatient visits for infants and toddlers. But several studies have shown that the current system needs improvement. For one thing, well-child-care guidelines issued by the American Academy of Pediatrics call for physicians to provide more services than can realistically be completed within a standard 15-minute office visit. As a result, many children do not get all of the preventive-care services that they need — and the problem is more acute for low-income families.

“The usual way of providing preventive care to young children is just not meeting the needs of the low-income families served by these clinics and practices,” says Tumaini Coker, MD ’01, assistant professor of pediatrics and a researcher with the Children’s Discovery and Innovation Institute at Mattel Children’s Hospital UCLA.

In a year-long study led by Dr. Coker, researchers developed a new design for preventive healthcare for children from birth through age 3 from low-income communities. The team partnered with two community pediatric practices and a multisite community-health center in Greater Los Angeles. “Our goal was to create an innovative and reproducible — but locally customizable — approach to deliver comprehensive preventive care that is more family-centered, effective and efficient,” Dr. Coker says.

To design the new care models, researchers gathered input from two sources. First, they solicited ideas from pediatricians, parents and health-plan representatives about topics such as having non-physicians provide routine preventive care and using alternative-visit formats — meeting with healthcare providers in alternative locations, meeting in groups as opposed to one-on-one or getting providers’ advice electronically instead of in person. Second, the teams surveyed existing literature on alternative providers, locations and formats for well-child care. From that information, four possible new models were developed for review by a panel of experts on preventive-care-practice redesign.

Two models were then selected to implement and test — one for private practices (one-on-one visits) and the other for a community-clinic setting (group-visit format). Both models shared several characteristics, including a “parent coach” to provide such services as preventive-health education, parenting education and preventive-health services related to development, behavior and family psychosocial concerns; longer preventive-care visits; a website that enables parents to customize their child’s specific needs prior to their visit; and scheduled text messages or phone calls enabling the healthcare team to communicate with parents.

The preventive-care models are now being tested in the clinical settings. “For clinics and practices that provide child preventive healthcare to families living in low-income communities, the process we used to develop the new models — or the new models themselves — could help them bring innovation to their own practices,” Dr. Coker says.

“Well-Child Care Clinical Practice Redesign for Serving Low-Income Children,” Pediatrics, June 16, 2014.

 


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IN THIS ISSUE
  • Toward a Bright Tomorrow
  • Surgery through the Lens of Google Glass
  • A Game-changer in the Fight against Melanoma
  • Ferric Factor
  • A Double Dose of Promising Lung-cancer Findings
  • The Healing Heart
  • Gene May Offer Target to Combat Parkinson’s Disease
  • The True Healthcare Costs of Undocumented Immigrants
  • Lost in Translation
  • Depression Increases Risk for Diabetic Seniors
  • Redesigning the Well-child Checkup
  • Change Agent
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  • Finding the Right Path
  • At the End of Too-few Days
  • Front-line Physician
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