THE CUTTING EDGE news + research Redesigning the Well-child Checkup 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 Illustration: Maja Moden