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Clinical practice redesign focuses on parents, children in low-income households

In an effort to redesign clinical practice, researchers developed comprehensive, site-specific and innovative models for the improved delivery of well-child care in small community practices and community health centers.

Studies have shown room for improvement in the current well-child care system, according to researcher Tumaini R. Coker, MD, MBA, of Mattel Children’s Hospital at the University of California Los Angeles, and colleagues. Pediatric providers struggle to provide the preventive and developmental services recommended by the AAP within a 15-minute office visit. As a result, many children do not receive all the preventative care services they need, a problem that occurs more frequently among children in low-income families.

 

Tumaini R. Coker

In response to these system deficiencies, researchers conducted working groups of parents, clinicians and staff to represent two clinical settings: a multisite community health center and two private practices that predominantly serve Medicaid-insured children. The working groups reviewed well-child care stakeholders’ perspectives and relevant literature to develop four comprehensive well-child care models for children aged 0 to 3 years. An expert panel reviewed the potential models in terms of the receipt of recommended services, family-centeredness, timely and appropriate follow-up, and feasibility and efficiency. Based on the expert panel’s ratings, the working groups chose one model to implement in each clinical setting.

A group visit model was chosen for the community health center. This model entails group visits that are scheduled in 2-hour blocks, with nine patients scheduled for each block. The group session is led by a health educator, with a physician available for the majority of the group session. Researchers estimated that during each block of time, the pediatrician should be able to see two additional patients. Under this model, pediatricians would devote the first 2 hours of a half-day session to the group visit and the second 2 hours of the half-day session to urgent visits.

A station-to-station model was chosen for the private practice setting. Visits are scheduled in 40-minute blocks, with the physician needed for 10 minutes of that block.

The working groups wanted both models to utilize a web-based pre-visit tool to focus the visit on parents’ needs. The tool would allow parents to select their priorities for the visit, complete prescreening questions, and receive anticipatory guidance via the Internet. The pre-visit tool would be completed at home prior to the visit or on a tablet or kiosk in the waiting room.

These new models of care rely on the health educator for routine well-child care services outside of physical examination. Researchers note this may alter the parent-physician relationship, and physician satisfaction may suffer as a result of being less integral to routine well-child care.

It is probable the duration of well-visits would be significantly longer, particularly in the group visit model, according to researchers. However, well-visit duration has been associated with content and quality of care and parent satisfaction with care.

“The usual way of providing preventative care to young children is just not meeting the needs of the low-income families served by these clinicians and practices. Our goal was to create an innovative and reproducible — but locally customizable — approach to deliver comprehensive preventative care that is more family-centered, effective, and efficient,” Coker said in a press release.

Disclosure: The researchers report no relevant financial disclosures.