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Jee SH, Conn AM, Conrow M, Alpert-Gillis L, Herendeen N. Just Stand There and Listen. Clin Pediatr (Phila) 2020; 59:749-751. [PMID: 32338041 DOI: 10.1177/0009922820915890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sandra H Jee
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Megan Conrow
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Neil Herendeen
- University of Rochester Medical Center, Rochester, NY, USA
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Needlman RD, Dreyer BP, Klass P, Mendelsohn AL. Attendance at Well-Child Visits After Reach Out and Read. Clin Pediatr (Phila) 2019; 58:9922818822975. [PMID: 30614260 DOI: 10.1177/0009922818822975] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Attendance at well-child visits (WCVs) is a sine qua non of preventive care. We hypothesized that Reach Out and Read (ROR) would be associated with better WCV attendance. Parents of children 76 to 72 months at 8 clinics who did not yet have ROR reported how many WCVs their child had attended in the previous year; separate samples at the same clinics were interviewed 16 months after the ROR program was instituted. Comparing 267 parents before ROR and 254 after, the percentage who had attended the minimum number of WCVs required by the American Academy of Pediatrics periodicity schedule rose from 67.4% (180/267) to 78.3% (199/254; P < .01). This difference remained significant after controlling for multiple potential confounding factors (estimated odds ratio = 2.1, 95% confidence interval = 1.3-3.5). The largest differences were among Latino children and children of less-educated parents. Programs to enhance early literacy may increase attendance at WCVs among at-risk families.
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Affiliation(s)
| | - Benard P Dreyer
- 2 New York University, New York, NY, USA
- 3 Bellevue Hospital Center, New York, NY, USA
| | - Perri Klass
- 2 New York University, New York, NY, USA
- 3 Bellevue Hospital Center, New York, NY, USA
| | - Alan L Mendelsohn
- 2 New York University, New York, NY, USA
- 3 Bellevue Hospital Center, New York, NY, USA
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Hsu HC, Lee SY, Lai CM, Tsai WL, Chiu HT. Effects of Pediatric Anticipatory Guidance on Mothers of Young Children. West J Nurs Res 2016; 40:305-326. [DOI: 10.1177/0193945916681292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Provision of anticipatory guidance to parents during well-child visits is a defining component of pediatric primary care. Using nationally representative data from the 2000 U.S. National Survey of Early Childhood Health, this study addressed the questions of whether, how, and what mothers of children below age 3 with different ethnic/racial background could benefit from anticipatory guidance. Structural equation modeling results showed that across ethnic/racial groups, guidance was directly associated with decreased maternal stress and directly and indirectly associated with effective parenting practices in child development, discipline, and safety. Moreover, guidance was consistently associated with decreased stress (effect size = .159/.123/.252) and increased effective parenting practices in child development (total effect = .090/.179/.296), discipline (total effect = .079/.138/.111), and safety (total effect = .186/.204/.229) in White/Black/Latino groups, respectively. Finally, whereas guidance was directly associated with child safety in all groups, it was indirectly contributed to child development and discipline via maternal stress in the Latino group only.
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Affiliation(s)
| | - Shih-Yu Lee
- University of Texas at Tyler, Tyler, TX, USA
| | - Chin-Man Lai
- Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Wan-Ling Tsai
- Taichung Veterans General Hospital and Hung Kuang University, Taichung City, Taiwan
| | - Hsiao-Tung Chiu
- Chung Shan Medical University Hospital, Taichung City, Taiwan
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Gellasch P. Developmental Screening in the Primary Care Setting: A Qualitative Integrative Review for Nurses. J Pediatr Nurs 2016; 31:159-71. [PMID: 26525281 DOI: 10.1016/j.pedn.2015.10.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 10/01/2015] [Accepted: 10/01/2015] [Indexed: 12/01/2022]
Abstract
UNLABELLED Standardized developmental screening leads to the identification of children with developmental delays who may benefit from early intervention. Many children with developmental delays are not identified early in life. An integrative review was performed to synthesize and critically analyze qualitative studies on the developmental screening experiences of parents and providers to develop a deeper understanding of the developmental screening gaps in clinical practice and increase awareness among healthcare professionals who care for children. ELIGIBILITY CRITERIA Qualitative studies written in English that focused on developmental screening in children from birth to school age and that included registered nurses, advanced practice nurses, pediatric or family physicians, or parents were considered. SAMPLE Ten studies met the inclusion criteria. RESULTS The analysis resulted in four main themes: developmental screening behaviors, developmental screening barriers, developmental screening facilitators, and parent interactions. CONCLUSIONS Positive parent interactions and practice-wide engagement facilitated successful implementation of standardized developmental screening in primary care settings. Barriers associated with developmental screening included time, lack of reimbursement, poor communication with parents, and unfamiliarity with developmental screening instruments. A limited number of studies have examined developmental screening methods used by advanced practice nurses. Only two studies in the review included advanced practice nurses. IMPLICATIONS The developmental screening experiences of providers and parents increases awareness about the challenges associated with conducting developmental screening in primary care. Recommendations for future research are offered with a focus on advanced practice nurses in primary care.
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Linking Family Economic Hardship to Early Childhood Health: An Investigation of Mediating Pathways. Matern Child Health J 2015. [DOI: 10.1007/s10995-015-1784-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Woolfenden S, Eapen V, Williams K, Hayen A, Spencer N, Kemp L. A systematic review of the prevalence of parental concerns measured by the Parents' Evaluation of Developmental Status (PEDS) indicating developmental risk. BMC Pediatr 2014; 14:231. [PMID: 25218133 PMCID: PMC4175611 DOI: 10.1186/1471-2431-14-231] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Accepted: 09/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parental concerns about their children's development can be used as an indicator of developmental risk. We undertook a systematic review of the prevalence of parents' concerns as an indicator of developmental risk, measured by the Parents' Evaluation of Developmental Status (PEDS) and associated risk factors. METHODS Electronic databases, bibliographies and websites were searched and experts contacted. Studies were screened for eligibility and study characteristics were extracted independently by two authors. A summary estimate for prevalence was derived. Meta-regression examined the impact of study characteristics and quality. Meta-analysis was used to derive pooled estimates of the impact of biological and psychosocial risk factors on the odds of parental concerns indicating high developmental risk. RESULTS Thirty seven studies were identified with a total of 210,242 subjects. Overall 13.8% (95% CI 10.9 -16.8%) of parents had concerns indicating their child was at high developmental risk and 19.8% (95% CI 16.7-22.9%) had concerns indicating their child was at moderate developmental risk. Male gender, low birth weight, poor/fair child health rating, poor maternal mental health, lower socioeconomic status (SES), minority ethnicity, not being read to, a lack of access to health care and not having health insurance were significantly associated with parental concerns indicating a high developmental risk. CONCLUSIONS The prevalence of parental concerns measured with the PEDS indicating developmental risk is substantial. There is increased prevalence associated with biological and psychosocial adversity. TRIAL REGISTRATION PROSPERO Registration: CRD42012003215.
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Affiliation(s)
- Susan Woolfenden
- />Department of Community Child Health, Sydney Children’s Hospital Network, High St Randwick NSW 2031, Sydney, Australia
- />School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | - Valsamma Eapen
- />School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Katrina Williams
- />Royal Children’s Hospital and Murdoch Children’s Research Institute, University of Melbourne, Melbourne, Australia
| | - Andrew Hayen
- />School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
| | | | - Lynn Kemp
- />School of Public Health and Community Medicine, University of New South Wales, Sydney, Australia
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Long WE, Cabral HJ, Garg A. Are components of the medical home differentially associated with child health care utilization, health, and health promoting behavior outcomes? Clin Pediatr (Phila) 2013; 52:423-32. [PMID: 23460651 DOI: 10.1177/0009922813479161] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine if specific components of the medical home are differentially associated with beneficial child outcomes. METHODS Logistic regression was used to model each component (family-centeredness, comprehensive care, and care coordination) with health care utilization, child health, and health promoting behaviors in 81 232 subjects from the 2003 National Survey of Children's Health. RESULTS Family-centeredness was associated with increased odds of children being read to (adjusted odds ratio [aOR] = 2.16). Comprehensive care was associated with decreased outpatient (aOR = 0.70) and emergency department (aOR = 0.79) sick visits and with increased child health per parental assessment (aOR = 1.50). Care coordination was associated with increased preventive care visits (aOR = 1.41) and increased outpatient (aOR = 1.21) and emergency department (aOR = 1.24) sick visits. Stratification by special health care needs demonstrated similar findings. CONCLUSIONS Comprehensive care was associated with improved child health and health care utilization. Prospective studies are needed to further investigate the differential impact of components of the medical home on child health.
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Affiliation(s)
- Webb E Long
- Division of General Pediatrics, Department of Pediatrics, Boston Medical Center/Boston University School of Medicine, 88 East Newton Street, Boston, MA 02118, USA.
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Abstract
PURPOSE To investigate practices, barriers, and facilitators of universal pre-school vision screening (PVS) at pediatric primary care offices. METHODS Focus group sessions (FGS) were moderated on-site at nine pediatric practices. A semi-structured topic guide was used to standardize and facilitate FGS. Discussions were audiotaped, and transcriptions were used to develop themes. All authors reviewed and agreed on the resultant themes. RESULTS FGS included 13 physicians and 32 nurses/certified medical assistants (CMAs), of whom 82% personally conducted some facet of PVS. In all practices, nurses/CMAs tested visual acuity (most using a non-recommended test), and physicians completed vision screening with external observation, fix/follow, red reflex, and cover test. Facilitators included (1) accepting that PVS is a routine part of the well-child visit, and (2) using an electronic medical record with prompts to record acuity (eight of nine practices). Barriers were related to difficulty testing pre-schoolers, distractions in the office setting, time constraints, and limited reimbursement. CONCLUSIONS Responsibility for PVS is shared by physicians and nurses/CMAs; thus, interventions to improve PVS should target both. Few practices are aware of new evidence-based PVS tests; thus, active translational efforts are needed to change current primary care practices.
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Affiliation(s)
- Robert Needlman
- Case Western Reserve University School of Medicine and Department of Pediatrics, MetroHealth Medical Center, Cleveland, Ohio 44109, USA.
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Pittard WB, Hulsey TC, Laditka JN, Laditka SB. School readiness among children insured by Medicaid, South Carolina. Prev Chronic Dis 2012; 9:E111. [PMID: 22677161 PMCID: PMC3457755 DOI: 10.5888/pcd9.110333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction The American Academy of Pediatrics recommends a schedule of age-specific well-child visits through age 21 years. For children insured by Medicaid, these visits are called Early and Periodic Screening, Diagnosis, and Treatment (EPSDT). These visits are designed to promote physical, emotional, and cognitive health. Six visits are recommended for the first year of life, 3 for the second year. We hypothesized that children with the recommended visits in the first 2 years of life would be more likely than others to be ready for school when they finish kindergarten. Methods We studied children insured by Medicaid in South Carolina, born during 2000 through 2002 (n = 21,998). Measures included the number of EPSDT visits in the first 2 years of life and an assessment of school readiness conducted at the end of kindergarten. We used logistic regression to examine the adjusted association between having the recommended visits and school readiness, controlling for characteristics of mothers, infants, prenatal care and delivery, and residence area. Results Children with the recommended visits had 23% higher adjusted odds of being ready for school than those with fewer visits. Conclusion EPSDT may contribute to school readiness for children insured by Medicaid. Children having fewer than the recommended EPSDT visits may benefit from school readiness programs.
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Affiliation(s)
- William B Pittard
- Department of Pediatrics, Division of Pediatric Epidemiology and Health Systems Research, Medical University of South Carolina, 165 Ashley Ave, Charleston, SC 29425, USA.
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Association of family-centered care with improved anticipatory guidance delivery and reduced unmet needs in child health care. Matern Child Health J 2012; 15:1228-37. [PMID: 21057865 DOI: 10.1007/s10995-010-0702-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Little is known about the association of family-centered care (FCC) with the quality of pediatric primary care. The objectives were to assess (1) associations between family-centered care (FCC), receipt of anticipatory guidance, and unmet need for health care; and (2) whether these associations vary for children with special health care needs (CSHCN). The study, a secondary data analysis of the 2004 Medical Expenditure Panel Survey, used a nationally representative sample of family members of children 0-17 years. We measured receipt of FCC in the last 12 months with a composite score average>3.5 on a 4 point Likert scale from 4 Consumer Assessment of Healthcare Providers and Systems questions. Outcome measures were six anticipatory guidance and six unmet health care service needs items. FCC was reported by 69.6% of family members. One-fifth (22.1%) were CSHCN. Thirty percent of parents reported≥4 of 6 anticipatory guidance topics discussed and 32.5% reported≥1 unmet need. FCC was positively associated with anticipatory guidance for all children (OR=1.45; 95% CI 1.19, 1.76), but no relation was found for CSHCN in stratified analyses (OR=1.01; 95% CI .75, 1.37). FCC was associated with reduced unmet needs (OR=.38; 95% CI .31, .46), with consistent findings for both non-CSHCN and CSHCN subgroups. Family-centered care is associated with greater receipt of anticipatory guidance and reduced unmet needs. The association between FCC and anticipatory guidance did not persist for CSHCN, suggesting the need for enhanced understanding of appropriate anticipatory guidance for this population.
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Stevens GD, Vane C, Cousineau MR. Association of experiences of medical home quality with health-related quality of life and school engagement among Latino children in low-income families. Health Serv Res 2011; 46:1822-42. [PMID: 21762145 PMCID: PMC3393027 DOI: 10.1111/j.1475-6773.2011.01292.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study examines whether patient-reported indicators of a quality medical home are associated with measures of health among Latino children in low-income families. DATA SOURCES Data on 3,258 children ages 2-18 years are from a cross-sectional survey of parents of children affiliated with California's Healthy Kids insurance. STUDY DESIGN Medical home quality was assessed using the Parents' Perception of Primary Care and was associated with health-related quality of life (HRQOL) overall and in four domains (physical, emotional, social, and school/daycare) and four measures of school engagement. PRINCIPAL FINDINGS A higher total medical home score was associated with a higher total Pediatric Quality of Life Inventory score and scores in four subdomains (total beta [B]=1.77, physical B=1.71, social B=1.36, emotional B=2.22, and school/daycare B=1.69, all p<0.001). It was also associated with missing fewer than three school days due to illness (odds ratio [OR]=1.12, 95 percent confidence intervals [CI]: 1.05, 1.19), excellent/above average school performance overall (OR=1.10, 95 percent CI: 1.03, 1.17) and performance in reading (OR=1.13, 95 percent CI: 1.06, 1.20) and math (OR=1.10, 95 percent CI: 1.03, 1.16). CONCLUSIONS Patient-reported medical home quality indicators are favorably associated with HRQOL and measures of school engagement among Latino children in low-income families.
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Affiliation(s)
- Gregory D Stevens
- Keck School of Medicine, University of Southern CaliforniaAlhambra, CA
| | | | - Michael R Cousineau
- Departments of Family Medicine and Preventive Medicine, Keck School of Medicine and the School of Policy Planning and Development, University of Southern CaliforniaAlhambra, CA
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Well-child care in infancy and emergency department use by South Carolina Medicaid children birth to 6 years old. South Med J 2011; 104:604-8. [PMID: 21886072 DOI: 10.1097/smj.0b013e31822426c0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This analysis tests the hypothesis that children enrolled in Medicaid with the recommended early and periodic screening, diagnosis and treatment (EPSDT) visits in the first 24 months utilize fewer emergency department (ED) services birth to 6 years old than children with fewer visits. METHODS Data represent all health encounters for a 3-year birth cohort of South Carolina children continuously enrolled in Medicaid from birth to 6 years old (n = 18,512). The association between receiving the American Academy of Pediatrics recommended EPSDT visits and other health service utilization is examined. RESULTS Children with the recommended EPSDT visits had a greater adjusted rate of sick-child visits with a primary care provider (rate ratio, 1.62; 95% CI 1.50- 1.76) and a lower adjusted rate of ED visits for ambulatory care-sensitive conditions (rate ratio, 0.88; 95% CI, 0.81-0.95). CONCLUSION Recommended EPSDT use in infancy may be associated with a shift in health care from the ED to the office setting by children enrolled in Medicaid in the first six years of life.
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Sens AE, Connors K, Bernstein HH. Anticipatory guidance: making it work for your patients and your practice. Pediatr Ann 2011; 40:435-41. [PMID: 21902120 DOI: 10.3928/00904481-20110815-06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Prevalence of parental concerns about childhood vaccines: the experience of primary care physicians. Am J Prev Med 2011; 40:548-55. [PMID: 21496754 DOI: 10.1016/j.amepre.2010.12.025] [Citation(s) in RCA: 145] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2010] [Revised: 12/09/2010] [Accepted: 12/23/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND Little is known about the effects of increased parental vaccine safety concerns on physicians' vaccine communication attitudes and practices. PURPOSE To assess among pediatricians and family medicine (FM) physicians: (1) prevalence of parental requests to deviate from recommended vaccine schedules; (2) responses to such requests; and (3) attitudes about the burden and success of vaccine communications with parents. METHODS Survey of nationally representative samples of pediatricians and FM physicians (N=696) conducted during February to May 2009 with analysis in 2010. RESULTS Response rates were 88% for pediatricians and 78% for FM physicians. Overall, 8% of physicians reported that ≥10% of parents refused a vaccine and 20% reported that ≥10% of parents requested to spread out vaccines in a typical month. More pediatricians than FM physicians reported always/often requiring parents to sign a form if they refused vaccination (53% vs 31%, p<0.0001); 64% of all physicians would agree to spread out vaccines in the primary series at least sometimes. When talking with parents with substantial concerns, 53% of physicians reported spending 10-19 minutes and 8% spending ≥20 minutes. Pediatricians were more likely than FM physicians to report their job less satisfying because of parental vaccine concerns (46% vs 21%, p<0.0001). Messages most commonly reported as "very effective" were personal statements such as what they would do for their own children. CONCLUSIONS The burden of communicating with parents about vaccines is high, especially among pediatricians. Physicians report the greatest success convincing skeptical parents using messages that rely on their personal choices and experiences.
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Hacker KA, Arsenault LN, Williams S, Digirolamo AM. Mental and behavioral health screening at preventive visits: opportunities for follow-up of patients who are nonadherent with the next preventive visit. J Pediatr 2011; 158:666-671.e2. [PMID: 21074180 DOI: 10.1016/j.jpeds.2010.09.059] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 08/13/2010] [Accepted: 09/22/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine the type of subsequent care received by children nonadherent with their next preventive visit and whether behavioral factors predict use of emergency or acute care in this population. STUDY DESIGN Data on 1703 children (4-16 years) screened at a preventive visit with the Pediatric Symptom Checklist (PSC)/Youth-PSC were examined to determine subsequent preventive care adherence (10-18 months later). Then, nonadherent children were monitored to determine whether they returned to their medical home for acute care, delayed preventive care, or visited the emergency department (ED). Multivariate analyses were conducted to determine whether demographic and behavioral factors predicted return to either acute care or ED care site. RESULTS Of the 461 children who were nonadherent with a second preventive care visit, most (85%) subsequently returned for acute, emergency, or delayed preventive care in the same medical system. Predictors of acute care or ED use included behavioral health risk characteristics (positive PSC, counseling, referral, parental concern), as well as adolescent age, self-pay and public insurance status, and living in lower socioeconomic communities. CONCLUSIONS Pediatricians should consider acute care or ED visits as opportunities for mental health screening follow-up, and intervention in populations at high risk who miss preventive care.
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Affiliation(s)
- Karen A Hacker
- Institute for Community Health, Cambridge Health Alliance, Cambridge, MA 02141, USA.
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Romaire MA, Bell JF. The medical home, preventive care screenings, and counseling for children: evidence from the Medical Expenditure Panel Survey. Acad Pediatr 2010; 10:338-45. [PMID: 20675211 DOI: 10.1016/j.acap.2010.06.010] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Revised: 05/21/2010] [Accepted: 06/16/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Little is known about the role of the medical home in promoting essential preventive health care services in the general pediatric population. This study examined associations between having a medical home and receipt of health screenings and anticipatory guidance. METHODS We conducted a cross-sectional analysis of the 2004-2006 Medical Expenditure Panel Survey (MEPS). Our sample included 21 055 children aged 0 to 17 years who visited a health care provider in the year prior to the survey. A binary indicator of the medical home was developed from 22 questions in MEPS, reflecting 4 of the 7 American Academy of Pediatrics' recommended components of the medical home: accessible, family-centered, comprehensive, and compassionate care. Multivariable logistic regression was used to examine the association between the medical home and receipt of specific health screenings and anticipatory guidance, controlling for confounding variables. RESULTS Approximately 49% of our study sample has a medical home. The medical home, defined when the usual source of care is a person or facility, is significantly associated with 3 health screenings (ie, weight, height, and blood pressure) and several anticipatory guidance topics (ie, advice about dental checkups, diet, exercise, car and bike safety), with odds ratios ranging from 1.26 to 1.54. CONCLUSIONS The medical home is associated with increased odds of children receiving some health screenings and anticipatory guidance. The medical home may provide an opportunity to improve the delivery of these services for children.
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Affiliation(s)
- Melissa A Romaire
- Department of Health Services, School of Public Health, University of Washington, Seattle, Washington 98195-7660, USA.
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Care Coordination for Children with Special Health Care Needs: Evaluation of a State Experiment. Matern Child Health J 2010; 15:993-1000. [DOI: 10.1007/s10995-010-0660-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Cullen L, Titler MG, Rempel G. An advanced educational program promoting evidence-based practice. West J Nurs Res 2010; 33:345-64. [PMID: 20705775 DOI: 10.1177/0193945910379218] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Evidence-based practice has led to improved health care quality and safety; greater patient, family, and staff satisfaction; and reduced costs. Despite these promising outcomes, use of evidence-based practice is inconsistent. The purpose of this article is to describe an advanced educational program for nurses in leadership roles responsible for guiding teams and mentoring colleagues through the challenges inherent in the evidence-based practice process. The Advanced Practice Institute: Promoting Adoption of Evidence-Based Practice is an innovative program designed to develop advanced skills essential for completing evidence-based practice projects and building organizational capacity for evidence-based practice programs. Learning is facilitated through group discussion, facilitated work time, networking, and consultation. Content includes finding and synthesizing evidence, learning effective strategies for implementation and evaluation, and discussing techniques for building an EBP program in the nurses' organization. Program evaluations are extremely positive, and the long-term impact is described.
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Affiliation(s)
- Laura Cullen
- Department of Nursing Services and Patient Care,University of Iowa Hospitals and Clinics, Iowa City, IA 52242-1009, USA.
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Olympia RP, Rivera R, Heverley S, Anyanwu U, Gregorits M. Natural disasters and mass-casualty events affecting children and families: a description of emergency preparedness and the role of the primary care physician. Clin Pediatr (Phila) 2010; 49:686-98. [PMID: 20356922 DOI: 10.1177/0009922810364657] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To determine the compliance of a select number of families with national recommendations for disaster preparedness. PATIENTS AND METHODS A questionnaire focusing on knowledge of community evacuation plans and the presence of a family emergency response plan was distributed simultaneously in Dauphin County, Pennsylvania, and Bronx County, New York. RESULTS A total of 1024 questionnaires were analyzed, and it was found that 35% (95% confidence interval [CI] = 32-38) of families were familiar with community evacuation plans, and 43% (95% CI = 40-46) had a family emergency response plan. Also, 17% (95% CI = 15-19) of respondents had discussed preparedness with their primary care physician; this subset of respondents was more likely to be familiar with community evacuation plans and was more likely to have a family emergency response plan. CONCLUSIONS These data show that families are, for the most part, not in compliance with national recommendations for preparedness. Families who discussed preparedness with their primary care physician were more likely to be compliant.
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Affiliation(s)
- Robert P Olympia
- Penn State Hershey Medical Center, Penn State Hershey Children's Hospital, Hershey, PA, USA.
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Cullen L, Adams S. What Is Evidence-Based Practice? J Perianesth Nurs 2010; 25:171-3. [DOI: 10.1016/j.jopan.2010.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2010] [Accepted: 03/08/2010] [Indexed: 10/19/2022]
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Arauz Boudreau AD, Fluet CF, Reuland CP, Delahaye J, Perrin JM, Kuhlthau K. Associations of providers' language and cultural skills with Latino parents' perceptions of well-child care. Acad Pediatr 2010; 10:172-8. [PMID: 20347415 DOI: 10.1016/j.acap.2010.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 01/05/2010] [Accepted: 01/05/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To assess the associations of parent-primary care provider language concordance and providers' self-rated cultural competency items with Latino parent report of well-child care quality. METHODS A cross-sectional survey of parents with children 10-50 months old and their children's providers in 3 community health centers. We used the mean scores of quality domains of the Promoting Healthy Development Survey to examine associations of parent-provider language concordance and providers' self-rated cultural competency items with the quality of well-child care provided (all scales range 0-100). RESULTS Results are based on 462 Latino parent responses and 22 provider responses. Latino parents in language concordant patient-provider relationships did not report higher-quality well-child care. Higher parent-reported quality of care was associated with provider self-reported effectiveness in treating Latino patients in the domains of family-centered care (mean 80.5 vs 70.6; P = .02) and helpfulness of care (mean 84.2 vs 67.9; P = .02). A language-cultural competency summary scale was associated with the domain assessing family risk factors (+11.2 points; P = .02) and its subdomain of emotional assessment (+16.1 points; P = .02). CONCLUSIONS Language concordance was not associated with parental reports of quality of well-child care. Provider self-perceived cultural competency was associated with higher scores in domains related to how content is delivered-that is, helpful and family-centered. The language-cultural competency summary score was associated with discussion of sensitive topics. These findings indicate that provider characteristics other than language concordance have greater association with quality of care and may offer opportunities to strengthen cultural competency, even among monolingual providers.
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Affiliation(s)
- Alexy D Arauz Boudreau
- MGH Center for Child and Adolescent Health Policy, and Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
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Does NursesʼPerceived Burn Prevention Knowledge and Ability to Teach Burn Prevention Correlate With Their Actual Burn Prevention Knowledge? J Burn Care Res 2010; 31:111-20. [DOI: 10.1097/bcr.0b013e3181cb8f0b] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Maulik PK, Darmstadt GL. Community-based interventions to optimize early childhood development in low resource settings. J Perinatol 2009; 29:531-42. [PMID: 19404276 DOI: 10.1038/jp.2009.42] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Interventions targeting the early childhood period (0 to 3 years) help to improve neuro-cognitive functioning throughout life. Some of the more low cost, low resource-intensive community practices for this age-group are play, reading, music and tactile stimulation. This research was conducted to summarize the evidence regarding the effectiveness of such strategies on child development, with particular focus on techniques that may be transferable to developing countries and to children at risk of developing secondary impairments. STUDY DESIGN PubMed, PsycInfo, Embase, ERIC, CINAHL and Cochrane were searched for studies involving the above strategies for early intervention. Reference lists of these studies were scanned and other studies were incorporated based on snow-balling. RESULT Overall, 76 articles corresponding to 53 studies, 24 of which were randomized controlled trials, were identified. Sixteen of those studies were from low- and middle-income countries. Play and reading were the two commonest interventions and showed positive impact on intellectual development of the child. Music was evaluated primarily in intensive care settings. Kangaroo Mother Care, and to a lesser extent massage, also showed beneficial effects. Improvement in parent-child interaction was common to all the interventions. CONCLUSION Play and reading were effective interventions for early childhood interventions in low- and middle-income countries. More research is needed to judge the effectiveness of music. Kangaroo Mother Care is effective for low birth weight babies in resource poor settings, but further research is needed in community settings. Massage is useful, but needs more rigorous research prior to being advocated for community-level interventions.
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Affiliation(s)
- P K Maulik
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA
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Abstract
OBJECTIVES The American Academy of Pediatrics recommends routine developmental screening in well-child care. Providers cite time restraints as a limitation preventing its widespread adoption. The objectives were to determine whether routine screening lengthened well-visits and was associated with changes in parent satisfaction and report of anticipatory guidance. METHODS Visits before and after implementation of routine screening were timed. Parents whose children were seen before or after screening began were contacted to query their perceptions of the visit. RESULTS There was no change in visit lengths after the screener was included. With screening, more parents reported their provider talked about their concerns, and that their questions were answered. There were no changes in parent satisfaction ratings or reports of anticipatory guidance discussions. CONCLUSIONS The perceived obstacle that routine screening requires more time than pediatricians have should not prevent its adoption. Screening tools may empower some parents otherwise reluctant to raise concerns unsolicited.
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Affiliation(s)
- Alison Schonwald
- Division of General Pediatrics, Children's Hospital, Boston, Massachusetts, Division of Developmental Medicine, Children's Hospital, Boston, Massachusetts, USA.
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Margolis PA, McLearn KT, Earls MF, Duncan P, Rexroad A, Reuland CP, Fuller S, Paul K, Neelon B, Bristol TE, Schoettker PJ. Assisting Primary Care Practices in Using Office Systems to Promote Early Childhood Development. ACTA ACUST UNITED AC 2008; 8:383-7. [DOI: 10.1016/j.ambp.2008.06.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Revised: 05/11/2008] [Accepted: 06/06/2008] [Indexed: 10/21/2022]
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Abstract
The field of pediatrics in the US began in late-nineteenth century urban slums, where young children were monitored to ensure they received safe milk and mothers were educated about nutrition and hygiene. The subsequent reduction of infectious disease through sanitation and vaccination, and a continuing appreciation of the powerful impact of the social context of children's well being, reinforced this early emphasis on preventive care. The past several decades have seen a shift in the distribution of childhood morbidity, as changing social patterns of family life and access to health care have increased the prevalence of chronic illness and developmental and emotional problems. More recently, practitioners and policymakers have recognized the importance of children's social and physical environments on life-long health and social competence. These changes are casting increasing attention on the preventive care available to young children and their families. Whereas public policies have provided most children with access to health care, questions have been raised about the content and quality of that care. Recommendations to improve the quality of preventive care include such strategies as risk-based individualized care plans; greater use of tested practice management tools, such as flow sheets and e-mail; team care; and standardized data collection, including structured screening. Both the content of preventive care and the training of practitioners to provide that care should be guided by a predetermined set of measurable outcomes for which providers should be held accountable, as well as other outcomes to which they should be expected to contribute.
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Mangione-Smith R, DeCristofaro AH, Setodji CM, Keesey J, Klein DJ, Adams JL, Schuster MA, McGlynn EA. The quality of ambulatory care delivered to children in the United States. N Engl J Med 2007; 357:1515-23. [PMID: 17928599 DOI: 10.1056/nejmsa064637] [Citation(s) in RCA: 448] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Little is known about the magnitude of deficits in the quality of care delivered to children, since comprehensive studies have been lacking. METHODS We assessed the extent to which care processes recommended for pediatric outpatients are delivered. Quality indicators were developed with the use of the RAND-UCLA modified Delphi method. Parents of 1536 children who were randomly selected from 12 metropolitan areas provided written informed consent to obtain medical records from all providers who had seen the children during the 2-year period before the date of study recruitment. Trained nurses abstracted these medical records. Composite quality scores were calculated by dividing the number of times indicated care was documented as having been ordered or delivered by the number of times a care process was indicated. RESULTS On average, according to data in the medical records, children in the study received 46.5% (95% confidence interval [CI], 44.5 to 48.4) of the indicated care. They received 67.6% (95% CI, 63.9 to 71.3) of the indicated care for acute medical problems, 53.4% (95% CI, 50.0 to 56.8) of the indicated care for chronic medical conditions, and 40.7% (95% CI, 38.1 to 43.4) of the indicated preventive care. Quality varied according to the clinical area, with the rate of adherence to indicated care ranging from 92.0% (95% CI, 89.9 to 94.1) for upper respiratory tract infections to 34.5% (95% CI, 31.0 to 37.9) for preventive services for adolescents. CONCLUSIONS Deficits in the quality of care provided to children appear to be similar in magnitude to those previously reported for adults. Strategies to reduce these apparent deficits are needed.
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Affiliation(s)
- Rita Mangione-Smith
- Department of Pediatrics, University of Washington, Child Health Institute, and Children's Hospital and Regional Medical Center, Seattle, WA 98115-8160, USA.
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The "Six T's": barriers to screening teens for substance abuse in primary care. J Adolesc Health 2007; 40:456-61. [PMID: 17448404 DOI: 10.1016/j.jadohealth.2006.12.007] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2006] [Revised: 11/20/2006] [Accepted: 12/01/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE To identify barriers to adolescent substance abuse screening in primary care. METHODS Focus groups were held at six primary care sites with a total of 38 providers. Providers brainstormed a list of barriers, collectively grouped similar barriers, and voted to produce a final ranked list. Two investigators qualitatively analyzed field notes and transcripts to triangulate findings, ranked the barriers across all sites by the number of groups identifying the barrier, then calculated a mean ranking (MR) for each. RESULTS The most commonly identified barrier was insufficient time (MR 1.8). Lack of training in how to manage a positive screen was ranked second (MR 1.7), but was linked to the first. Providers reported they had enough time to administer a short screen, but insufficient time to manage a positive result during the well care visit. The need to triage competing problems (MR 3.0), lack of treatment resources (MR 3.3), tenacious parents who would not leave the room for a confidential discussion (MR 2.5), and unfamiliarity with screening tools (MR 3.0) were also noted by more than one group. CONCLUSIONS Insufficient time and lack of training in how to manage positive screens are the greatest barriers to screening adolescents for substance abuse. This suggests that some providers might differentially avoid screening youth who they suspect will screen positive, yet these patients would benefit most from early recognition. More research is needed on effective ways to manage positive substance abuse screens in primary care.
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Rosenthal MS, Socolar RR, DeWalt DA, Pignone M, Garrett J, Margolis PA. Parents with low literacy report higher quality of parent-provider relationships in a residency clinic. ACTA ACUST UNITED AC 2007; 7:51-5. [PMID: 17261483 DOI: 10.1016/j.ambp.2006.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2006] [Revised: 10/03/2006] [Accepted: 10/09/2006] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Quality of care in pediatrics is suboptimal for many children from families of low socioeconomic status. Literacy is one aspect of socioeconomic status. We hypothesized that low parental literacy would be associated with low-quality well-child care. METHODS We performed a cross-sectional study of caregivers of 1- to 4- year-old children in a pediatric resident clinic. To assess parental literacy, we used the Rapid Estimate of Adult Literacy in Medicine. To assess the quality of well-child care, we used 5 subscales from the Promoting Healthy Development Survey relevant to either provider-parent relationships or content of discussions in the well-child visit. RESULTS We enrolled 157 caregivers. The mean age of the respondents was 30 years, 55% were African American, 69% received Medicaid, and 85% had graduated high school. A total of 34% of the respondents scored below a ninth-grade reading level (low literacy). Parents with low literacy were more likely than those with higher literacy to report Family-centered care (79% vs 61%, P = .03), and Helpfulness and Confidence building (79% vs 57%, P = .01). There was no difference, by literacy level, in the percentage of parents who reported reaching established threshold levels for discussion of Psychosocial issues, Safety issues, or Anticipatory guidance topics. CONCLUSIONS The lower-literacy respondents reported higher-quality parent-provider relationships; there was no difference in quality of content of discussions by literacy level. Parents with low literacy may have lower expectations regarding relationships with their health care provider or may be less likely to be critical. Alternatively, pediatric residents may be more effective at relationship building with low-literacy families.
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Affiliation(s)
- Marjorie S Rosenthal
- Robert Wood Johnson Clinical Scholars Program and Division of General Pediatrics, Yale University School of Medicine, New Haven, CT 06520, USA.
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Houtrow AJ, Kim SE, Chen AY, Newacheck PW. Preventive health care for children with and without special health care needs. Pediatrics 2007; 119:e821-8. [PMID: 17403825 PMCID: PMC2367154 DOI: 10.1542/peds.2006-1896] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of this study was to compare the receipt of preventive health services for children with and without special health care needs and to identify predictors of these health services for children with special health care needs using nationally representative data. METHODS Data from the 2002 and 2003 Medical Expenditure Panel Surveys were analyzed. A total of 18,279 children aged 3 to 17 years were included in our study. The Child Preventive Health Supplement was used to identify caregiver recall of specific health screening measures and anticipatory guidance during the previous 12 months. Odds ratios were calculated for predictive factors of preventive services for children with special health care needs. RESULTS The prevalence of special health care needs in children aged 3 to 17 years was 21.6%. Based on caregiver reports, 87.5% of children with special health care needs had > or = 1 health screening measure checked in the past year compared with 73.1% of children without special health care needs. Receipt of > or = 1 topic of anticipatory guidance was reported for 69.8% of children with special health care needs compared with 55.2% of children without special health care needs. Black and Hispanic caregivers of children with special health care needs were more likely than others to report receipt of all 6 categories of anticipatory guidance measured in this study. CONCLUSIONS We found that caregivers of children with special health care needs were more likely to report receipt of anticipatory guidance and health screening than were caregivers of children without special health care needs. Although a majority of these caregivers reported receiving some health screening and anticipatory guidance on an annual basis, there are clear gaps in the delivery of preventive health services. This study identifies areas for improvement in the delivery of preventive health services for children with special health care needs and children in general.
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Affiliation(s)
- Amy J Houtrow
- Department of Pediatrics, University of California at San Francisco, San Francisco, California, USA.
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Schor EL, Abrams M, Shea K. Medicaid: health promotion and disease prevention for school readiness. Health Aff (Millwood) 2007; 26:420-9. [PMID: 17339669 DOI: 10.1377/hlthaff.26.2.420] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Medicaid's child health program, Early and Periodic Screening, Diagnosis, and Treatment (EPSDT), emphasizes health promotion and disease prevention as vehicles to ensure that children are ready for school and able to succeed in life. Required components of preventive care can be mapped to specific health outcomes that are important attributes of school readiness and prerequisites for educational success. The federal government and states can take specific action to assure that children receive all of the health care services, including preventive services, necessary to promote their optimal health and development and, thus, to maximize their future productivity.
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Selden TM. Compliance with well-child visit recommendations: evidence from the Medical Expenditure Panel Survey, 2000-2002. Pediatrics 2006; 118:e1766-78. [PMID: 17142499 DOI: 10.1542/peds.2006-0286] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES This study examines national compliance rates with well-child visit recommendations using the Medical Expenditure Panel Survey. The Medical Expenditure Panel Survey provides nationally representative information on preventative care for children, combining visit-level data over a 2-year period with a rich array of socioeconomic and health status measures. METHODS Visit-level data from 2000 to 2002 were used to construct a well-child visit "compliance" measure equal to well-child visits as a percentage of age-specific recommendations from the American Academy of Pediatrics. Compliance was examined across age, gender, race/ethnicity, health status, poverty, insurance coverage, eligibility for public coverage, family structure, parent education, insurance, citizenship and country of origin, language, urbanicity, and census division. RESULTS On average, 56.3% of all children aged 0 to 18 years had no well-child visits during a 12-month period, and 39.4% had no well-child visits over a 2-year period. The average compliance ratio was 61.4%. Large differences in compliance exist among children. High compliance rates were observed among infants (83.2%), children with special health care needs (86.6%), children with college-educated parents (74.3%), children with family incomes >4 times the poverty level (71.6%), and children in the New England (94.6%) and Middle Atlantic (83.2%) census divisions. Low levels of compliance were observed among uninsured children (35.3%) and especially uninsured children simulated to be eligible for public coverage (28.4%). Other groups with low compliance rates include teenagers (49.2%), noncitizen children (43.9%), and children in the West South Central (44.9%), East South Central (48.8%), and Mountain (49.7%) census divisions. CONCLUSIONS Well-child visit compliance in the Medical Expenditure Panel Survey is less than found in other household surveys, yet consistent with or above results based on data from provider and claims data. Although experts dispute the optimal frequency of well-child visits, the disparities observed in compliance rates among population subgroups raise important public health concerns.
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Affiliation(s)
- Thomas M Selden
- Division of Modeling and Simulation, Center for Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality, 540 Gaither Rd, Rockville, MD 20850, USA.
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Serwint JR, Thoma KA, Dabrow SM, Hunt LE, Barratt MS, Shope TR, Darden PM. Comparing patients seen in pediatric resident continuity clinics and national ambulatory medical care survey practices: a study from the continuity research network. Pediatrics 2006; 118:e849-58. [PMID: 16923927 DOI: 10.1542/peds.2006-0422] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES The goal was to compare visit data from Continuity Research Network practices with data for a nationally representative sample of pediatric visits in practice settings from the National Ambulatory Medical Care Survey. METHODS A cross-sectional study comparing data for Continuity Research Network practice visits during a 1-week period in 2002 with data from the 2000 National Ambulatory Medical Care Survey was performed. Continuity Research Network and National Ambulatory Medical Care Survey data were derived from 30 patient visits per practice site for patients < 22 years of age, with the primary care providers being residents and practicing pediatricians, respectively. RESULTS Eighteen Continuity Research Network practices reported on 540 visits, compared with 32 National Ambulatory Medical Care Survey physicians reporting on 792 visits. Continuity Research Network patients were more likely to be black non-Hispanic or Hispanic/Latino and to have public insurance. The top 5 reasons for visits were the same for Continuity Research Network and National Ambulatory Medical Care Survey visits, although the orders varied slightly. These 5 reasons accounted for 58% of Continuity Research Network visits and 49% of National Ambulatory Medical Care Survey visits. Continuity Research Network visits were more likely to result in patient instructions to return at a specific time (78% vs 52%). CONCLUSIONS Residents in Continuity Research Network practices provide care to more underserved patients but evaluate problems that are similar to those observed in office practices; the Continuity Research Network practices thus provide important training experiences for residents who will serve both minority and nonminority children.
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Chung PJ, Lee TC, Morrison JL, Schuster MA. Preventive care for children in the United States: quality and barriers. Annu Rev Public Health 2006; 27:491-515. [PMID: 16533127 DOI: 10.1146/annurev.publhealth.27.021405.102155] [Citation(s) in RCA: 119] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Our objective was to examine the academic literature covering quality of childhood preventive care in the United States and to identify barriers that contribute to poor or disparate quality. We systematically reviewed articles related to childhood preventive care published from 1994 through 2003, focusing on 58 large observational studies and interventions addressing well-child visit frequency, developmental and psychosocial surveillance, disease screening, and anticipatory guidance. Although many children attend recommended well-child visits and receive comprehensive preventive care at those visits, many do not attend such visits. Estimates of children who attend all recommended visits range widely (from 37%-81%). In most studies, less than half is the proportion of children who receive developmental or psychosocial surveillance, adolescents who are asked about various health risks, children at risk for lead exposure who are screened, adolescents at risk for Chlamydia who are tested, or children and adolescents who receive anticipatory guidance on various topics. Major barriers include lack of insurance, lack of continuity with a clinician or place of care, lack of privacy for adolescents, lack of clinician awareness or skill, racial/ethnic barriers, language-related barriers, clinician and patient gender-related barriers, and lack of time. In summary, childhood preventive care quality is mixed, with large disparities among populations. Recent research has identified barriers that might be overcome through practice and policy interventions.
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Affiliation(s)
- Paul J Chung
- Department of Pediatrics, David Geffen School of Medicine, University of California, Los Angeles, California 90095, USA.
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Abstract
Primary care clinicians confront a long list of topics that are supposed to be covered during well-child visits, but evidence for the effectiveness of preventive counseling for most issues is limited, and it is doubtful that covering more topics confers correspondingly enhanced clinical benefits. Amid growing professional interest in rethinking primary care, 3 ideas that would facilitate constructive change are proposed. First, face-to-face time between doctors and parents should be allocated as a scarce resource, with priority given to topics that are both important and uniquely responsive to in-office intervention. Second, to maximize the educational value of anticipatory guidance, visits could focus on experiential, as opposed to merely didactic, learning. Finally, recommendations for primary care should be based on evidence, rather than expert opinion. Competing protocols for preventive care ought to be subjected to large-scale, coordinated research. The unit of analysis should be the visit or series of visits, rather than a single intervention. A crucial first step would be the definition of universal outcome measures.
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Affiliation(s)
- Robert Needlman
- Department of Pediatrics, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA.
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Cohen AL, Christakis DA. Primary language of parent is associated with disparities in pediatric preventive care. J Pediatr 2006; 148:254-8. [PMID: 16492438 DOI: 10.1016/j.jpeds.2005.10.046] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2003] [Revised: 08/23/2005] [Accepted: 10/03/2005] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine whether infants of parents whose primary language is not English are less likely to receive recommended preventive care than infants of parents whose primary language is English. STUDY DESIGN We conducted a retrospective cohort study of all 38,793 1-year-old Medicaid-enrolled infants born in Washington state between January 1, 1999 and September 30, 2000. The main exposure was self-reported primary language of parents. Using multivariate regression, we estimated the relative risk of receiving appropriate and timely receipt of preventive care visits in the first year as recommended by the American Academy of Pediatrics and Washington state Medicaid. RESULTS Fewer than 1 in 6 (15.4%) infants received all 6 recommended preventive care visits in their first year of life. Infants of parents whose primary language was not English were half as likely to receive all recommended preventive care visits compared with infants of parents whose primary language was English (adjusted relative risk = 0.53; 95% confidence interval = 0.49 to 0.58). This disparity was seen in white, Hispanic, and African-American infants, but not in Asian-American infants. CONCLUSIONS Disparities based on primary language exist in receipt of recommended pediatric preventive care in white, Hispanic, and African-American infants enrolled in Medicaid.
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Affiliation(s)
- Adam L Cohen
- Department of Pediatrics, Child Health Institute, and Children's Hospital and Regional Medical Center, University of Washington, Seattle, WA, USA.
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Abstract
PURPOSE OF REVIEW This article reviews the impact of the Medicaid program, including the proportion of children in America insured by Medicaid; the extent to which Medicaid-enrolled children have access to care; the use of services and the quality of care received by Medicaid enrollees, including evidence for disease reduction; and family satisfaction with the program. RECENT FINDINGS More than a quarter of all children in the United States were insured through public programs, primarily Medicaid, in 2002. Public insurance programs are even more critical for low-income children: 69.5% of children in families with incomes below 100% of the federal poverty level are covered by public programs. The reach of Medicaid is extensive, although substantial numbers of eligible children remain uninsured. Although Medicaid-insured children still face access barriers, particularly for certain types of specialty care, parents of children with public insurance report high levels of satisfaction with their experience with well-child care. While the study findings are mixed, several recent studies show very favorable comparisons between the experience of privately insured children and that of publicly insured children. SUMMARY Medicaid plays a critical role in providing health insurance coverage for children, particularly for very low-income families. Additional efforts are needed to fully enroll all eligible families and to assure full access to high-quality care.
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Affiliation(s)
- Patrick M Vivier
- Department of Community Health, Brown Medical School, Providence, Rhode Island 02912, USA.
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Stevens GD, Mistry R, Zuckerman B, Halfon N. The parent-provider relationship: does race/ethnicity concordance or discordance influence parent reports of the receipt of high quality basic pediatric preventive services? J Urban Health 2005; 82:560-74. [PMID: 16221918 PMCID: PMC3456673 DOI: 10.1093/jurban/jti125] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Recent research among adults suggests that having a provider of the same race/ethnicity may enhance the quality of health care above and beyond just having any regular source of care. It is not known whether such relationships exist in pediatric care. The purpose of this study is to identify the distribution and methods by which families have a race/ethnicity concordant provider of well-child care and examine whether differences exist in the receipt of basic preventive services (BPS) and family-centered care (FCC) among those with concordant, discordant, and no regular providers. Analyses are stratified by geography to assess whether urban versus nonurban setting moderates these differences. This study uses publicly available data from the 2000 National Survey of Early Childhood Health (NSECH), a nationally representative, cross-sectional telephone survey of parents of children ages 4-35 months (n = 1,996). African Americans and Latinos were more likely than whites to lack a regular provider of well-child care (60.9% and 65.7% vs. 50.6%) and less likely to have a concordant provider (9.8% and 5.7% vs. 38.5%) (P < .001). African Americans with a regular provider were about three times more likely to establish a concordant relationship in urban versus nonurban settings (32.4% vs. 12.5%, P < .01). No statistically significant differences in BPS or FCC were found by concordance versus discordance for any group, a finding that held regardless of geographic setting. White children with no regular provider received better BPS than those with a discordant provider (e.g., excellent BPS of 37.2% vs. 27.1%, P < .05), but children with no regular provider were more likely than those with either concordant or discordant providers to have lower FCC in one (Latinos, whites) or three domains (African Americans). Despite racial/ethnic differences in the likelihood of having a concordant regular provider of well-child care, no disparities were found in BPS or FCC associated with discordance, even after stratification by urban/nonurban setting. Lacking a regular provider was associated with lower FCC versus having either a concordant or discordant provider, suggesting that efforts to improve these aspects of well-child care might focus less on linking children with a race/ethnicity concordant provider and more on social, cultural, and linguistic factors that impact having any regular provider.
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Affiliation(s)
- Gregory D Stevens
- Division of Community Health, University of Southern California, Keck School of Medicine, 1000 South Fremont Avenue, Building A7, Alhambra, CA 91803, USA.
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Shi L, Stevens GD. Disparities in access to care and satisfaction among U.S. children: the roles of race/ethnicity and poverty status. Public Health Rep 2005; 120:431-41. [PMID: 16025723 PMCID: PMC1497738 DOI: 10.1177/003335490512000410] [Citation(s) in RCA: 70] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The study assessed the progress made toward reducing racial and ethnic disparities in access to health care among U.S. children between 1996 and 2000. METHODS Data are from the Household Component of the 1996 and 2000 Medical Expenditure Panel Survey. Bivariate associations of combinations of race/ethnicity and poverty status groups were examined with four measures of access to health care and a single measure of satisfaction. Logistic regression was used to examine the association of race/ethnicity with access, controlling for sociodemographic factors associated with access to care. To highlight the role of income, we present models with and without controlling for poverty status. RESULTS Racial and ethnic minority children experience significant deficits in accessing medical care compared with whites. Asians, Hispanics, and blacks were less likely than whites to have a usual source of care, health professional or doctor visit, and dental visit in the past year. Asians were more likely than whites to be dissatisfied with the quality of medical care in 2000 (but not 1996), while blacks and Hispanics were more likely than whites to be dissatisfied with the quality of medical care in 1996 (but not in 2000). Both before and after controlling for health insurance coverage, poverty status, health status, and several other factors associated with access to care, these disparities in access to care persisted between 1996 and 2000. CONCLUSIONS Continued monitoring of racial and ethnic differences is necessary in light of the persistence of racial/ethnic and socioeconomic disparities in access to care. Given national goals to achieve equity in health care and eliminate racial/ ethnic disparities in health, greater attention needs to be paid to the interplay of race/ethnicity factors and poverty status in influencing access.
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Affiliation(s)
- Leiyu Shi
- Department of Health Policy and Management, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD 21205-1996, USA.
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