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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