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Aloe CF, Hall KL, Pérez-Escamilla R, Rosenthal MS, Fenick AM, Sharifi M. Multilevel Factors Associated With Participation in Group Well-Child Care. Acad Pediatr 2023; 23:1376-1384. [PMID: 36933616 DOI: 10.1016/j.acap.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 03/08/2023] [Accepted: 03/10/2023] [Indexed: 03/20/2023]
Abstract
OBJECTIVE To identify factors associated with participation in group well-child care (GWCC), wherein families share preventive health care visits. METHODS We extracted electronic health record data of mother-infant dyads with infants born 2013-18 at Yale New Haven Hospital and followed at the primary care center. Using chi-square analysis and multivariate logistic regression, we examined the extent to which 1) maternal/infant characteristics and recruitment timing were associated with GWCC initiation and continued engagement and 2) initiation was associated with primary care visits. RESULTS Of 2046 eligible mother-infant dyads, 11.6% initiated GWCC. The odds of initiation were higher among mothers with Spanish versus English primary language (odds ratio: 2.36 [95% confidence interval: 1.52-3.66]), with 1 child versus ≥ 3 children (1.58 [1.13-2.22]), and of non-Hispanic Black versus non-Hispanic White infants (2.72 [1.39-5.32]). Initiation was lower among infants born in 2016 (0.53 [0.32-0.88]) and 2018 (0.29 [0.17-0.52]) versus 2013. Among GWCC initiators with follow-up data (n = 217), continued engagement (n = 132, 60.8%) was positively associated with maternal age of 20-29 years (2.85 [1.10-7.34]) and > 30 years (3.46 [1.15-10.43]) compared with< 20 years, and mothers with 1 child versus ≥ 3 (2.28 [1.04-4.98]). GWCC initiators, versus non-initiators, had 5.06 times higher adjusted odds of attending > 9 primary care appointments in the first 18 months (95% confidence interval: 3.74-6.85). CONCLUSIONS As evidence builds on health and social benefits of GWCC, recruitment efforts may gain from considering multi-level socio-economic, demographic, and cultural factors associated with GWCC participation. Higher participation among systemically marginalized groups may present unique opportunities for family-based health promotion to mitigate health inequities.
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Affiliation(s)
- Carlin F Aloe
- Department of Pediatrics (CF Aloe, MS Rosenthal, AM Fenick, and M Sharifi), Yale School of Medicine, New Haven, Conn.
| | - Kelly L Hall
- Yale School of Public Health (KL Hall, R Pérez-Escamilla, and M Sharifi), New Haven, Conn.
| | - Rafael Pérez-Escamilla
- Yale School of Public Health (KL Hall, R Pérez-Escamilla, and M Sharifi), New Haven, Conn.
| | - Marjorie S Rosenthal
- Department of Pediatrics (CF Aloe, MS Rosenthal, AM Fenick, and M Sharifi), Yale School of Medicine, New Haven, Conn.
| | - Ada M Fenick
- Department of Pediatrics (CF Aloe, MS Rosenthal, AM Fenick, and M Sharifi), Yale School of Medicine, New Haven, Conn.
| | - Mona Sharifi
- Department of Pediatrics (CF Aloe, MS Rosenthal, AM Fenick, and M Sharifi), Yale School of Medicine, New Haven, Conn; Yale School of Public Health (KL Hall, R Pérez-Escamilla, and M Sharifi), New Haven, Conn.
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2
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Gresh A, Wilson D, Fenick A, Patil CL, Coker T, Rising SS, Glass N, Platt R. A Conceptual Framework for Group Well-Child Care: A Tool to Guide Implementation, Evaluation, and Research. Matern Child Health J 2023; 27:991-1008. [PMID: 37014564 PMCID: PMC10071241 DOI: 10.1007/s10995-023-03641-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 04/05/2023]
Abstract
OBJECTIVE To use scoping review methods to construct a conceptual framework based on current evidence of group well-child care to guide future practice and research. METHODS We conducted a scoping review using Arksey and O'Malley's (2005) six stages. We used constructs from the Consolidated Framework for Implementation Research and the quadruple aim of health care improvement to guide the construction of the conceptual framework. RESULTS The resulting conceptual framework is a synthesis of the key concepts of group well-child care, beginning with a call for a system redesign of well-child care to improve outcomes while acknowledging the theoretical antecedents structuring the rationale that supports the model. Inputs of group well-child care include health systems contexts; administration/logistics; clinical setting; group care clinic team; community/patient population; and curriculum development and training. The core components of group well-child care included structure (e.g., group size, facilitators), content (e.g., health assessments, service linkages). and process (e.g., interactive learning and community building). We found clinical outcomes in all four dimensions of the quadruple aim of healthcare. CONCLUSION Our conceptual framework can guide model implementation and identifies several outcomes that can be used to harmonize model evaluation and research. Future research and practice can use the conceptual framework as a tool to standardize model implementation and evaluation and generate evidence to inform future healthcare policy and practice.
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Affiliation(s)
- Ashley Gresh
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA.
| | - Deborah Wilson
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA
| | - Ada Fenick
- Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Crystal L Patil
- College of Nursing, University of Illinois Chicago, 845 S Damen Ave, Chicago, IL, 60612, USA
| | - Tumaini Coker
- Seattle Children's Research Institute, University of Washington School of Medicine, Seattle, USA
| | | | - Nancy Glass
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA
| | - Rheanna Platt
- Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, USA
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3
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Coker TR, Liljenquist K, Lowry SJ, Fiscella K, Weaver MR, Ortiz J, LaFontaine R, Silva J, Salaguinto T, Johnson G, Friesema L, Porras-Javier L, Guerra LJS, Szilagyi PG. Community Health Workers in Early Childhood Well-Child Care for Medicaid-Insured Children: A Randomized Clinical Trial. JAMA 2023; 329:1757-1767. [PMID: 37120800 PMCID: PMC10150321 DOI: 10.1001/jama.2023.7197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/13/2023] [Indexed: 05/01/2023]
Abstract
Importance An intervention model (the Parent-focused Redesign for Encounters, Newborns to Toddlers; the PARENT intervention) for well-child care that integrates a community health worker into preventive care services may enhance early childhood well-child care. Objective To examine the effectiveness of the PARENT intervention vs usual care for parents with children younger than 2 years of age. Design, Setting, and Participants A cluster randomized clinical trial was conducted between March 2019 and July 2022. Of the 1283 parents with a child younger than 2 years of age presenting for a well-child visit at 1 of the 10 clinic sites (2 federally qualified health centers in California and Washington) approached for trial participation, 937 were enrolled. Intervention Five clinics implemented the PARENT intervention, which is a team-based approach to care that uses a community health worker in the role of a coach (ie, health educator) as part of the well-child care team to provide comprehensive preventive services, and 5 clinics provided usual care. Main Outcomes and Measures There were 2 primary outcomes: score for parent-reported receipt of recommended anticipatory guidance during well-child visits (score range, 0-100) and emergency department (ED) use (proportion with ≥2 ED visits). The secondary outcomes included psychosocial screening, developmental screening, health care use, and parent-reported experiences of care. Results Of the 937 parents who were enrolled, 914 remained eligible to participate (n = 438 in the intervention group and n = 476 in the usual care group; 95% were mothers, 73% reported Latino ethnicity, and 63% reported an annual income <$30 000). The majority (855/914; 94%) of the children (mean age, 4.4 months at parental enrollment) were insured by Medicaid. Of the 914 parents who remained eligible and enrolled, 785 (86%) completed the 12-month follow-up interview. Parents of children treated at the intervention clinics (n = 375) reported receiving more anticipatory guidance than the parents of children treated at the usual care clinics (n = 407) (mean score, 73.9 [SD, 23.4] vs 63.3 [SD, 27.8], respectively; adjusted absolute difference, 11.01 [95% CI, 6.44 to 15.59]). There was no difference in ED use (proportion with ≥2 ED visits) between the intervention group (n = 376) and the usual care group (n = 407) (37.2% vs 36.1%, respectively; adjusted absolute difference, 1.2% [95% CI, -5.5% to 8.0%]). The effects of the intervention on the secondary outcomes included a higher amount of psychosocial assessments performed, a greater number of parents who had developmental or behavioral concerns elicited and addressed, increased attendance at well-child visits, and greater parental experiences with the care received (helpfulness of care). Conclusions and Relevance The intervention resulted in improvements in the receipt of preventive care services vs usual care for children insured by Medicaid by incorporating community health workers in a team-based approach to early childhood well-child care. Trial Registration ClinicalTrials.gov Identifier: NCT03797898.
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Affiliation(s)
- Tumaini R. Coker
- Seattle Children’s Research Institute, Seattle Children’s Hospital, Seattle, Washington
- Department of Pediatrics, School of Medicine, University of Washington, Seattle
| | - Kendra Liljenquist
- Seattle Children’s Research Institute, Seattle Children’s Hospital, Seattle, Washington
- Department of Pediatrics, School of Medicine, University of Washington, Seattle
| | - Sarah J. Lowry
- Seattle Children’s Research Institute, Seattle Children’s Hospital, Seattle, Washington
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester, Rochester, New York
| | | | - Janette Ortiz
- Department of Pediatrics, University of California, Los Angeles
| | - Rachel LaFontaine
- Department of Pediatrics, School of Medicine, University of Washington, Seattle
| | - Javier Silva
- School of Public Health, University of Washington, Seattle
| | - Taylor Salaguinto
- Seattle Children’s Research Institute, Seattle Children’s Hospital, Seattle, Washington
| | - Gina Johnson
- Northeast Valley Health Corporation, San Fernando, California
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4
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Beldick SR, Rohde JF, Short VL, Abatemarco D, Goyal NK. Pediatric Primary Care Diagnoses Among Children with Intrauterine Opioid Exposure. J Health Care Poor Underserved 2023; 34:161-179. [PMID: 37464487 PMCID: PMC10483573 DOI: 10.1353/hpu.2023.0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
BACKGROUND AND OBJECTIVES Characterizing common concerns for children with intrauterine opioid exposure (IOE) can inform tailored primary care. METHODS Retrospective analysis of primary care data of children with IOE from birth to age two years within one multi-state pediatric health system. Well child care (WCC) and problem-based visit diagnoses were categorized, and descriptive statistics were tabulated. RESULTS Three hundred and eighty-five (385) children with IOE had 3,622 primary care visits, of which 51.4% were WCC and 48.6% were problem-based. Most frequent visit diagnoses were upper respiratory complaints (14.8% of visits), feeding difficulties (12.2%), and perinatal viral exposure (9.8%). Although visit type (WCC vs. problem-based) varied across diagnostic category, frequent utilization of both visit types were documented for several diagnoses in infancy (e.g., fussiness/colic, feeding difficulties). CONCLUSIONS Well child care visits for children with IOE are key opportunities for anticipatory guidance with an emphasis on problems that may contribute to acute health care utilization, particularly in early infancy.
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Affiliation(s)
| | | | - Vanessa L. Short
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia PA
| | - Diane Abatemarco
- Department of Obstetrics & Gynecology, Thomas Jefferson University, Philadelphia PA
| | - Neera K. Goyal
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia PA
- Nemours Children’s Health, Philadelphia, PA
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5
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Akhtar SS, Heydon S, Norris P. Access to the healthcare system: Experiences and perspectives of Pakistani immigrant mothers in New Zealand. J Migr Health 2022; 5:100077. [PMID: 35024677 PMCID: PMC8724945 DOI: 10.1016/j.jmh.2021.100077] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/17/2021] [Accepted: 12/20/2021] [Indexed: 11/24/2022] Open
Abstract
Worldwide, there is limited literature on Pakistani immigrants' challenges and experiences accessing healthcare services for their children and themselves. In this article, we present a case study of Pakistani immigrant mothers in New Zealand to explore their experiences and perspectives on navigating the healthcare system of a new country. Data was collected from 23 mothers in Wellington through in-depth semi-structured interviews, which each lasted 60 to 80 min. Participants had been living in New Zealand for an average of 3.25 years and were mostly highly educated. They talked about their prior knowledge and experiences regarding the New Zealand healthcare system. Lack of knowledge, different expectations, and experiences of healthcare services inhibited their utilization of healthcare. Most mothers treated their children at home before visiting a general practitioner (GP) due to previous perceived unsatisfactory experiences, such as lack of availability of GP appointments for the same or next day, or long waiting times at emergency departments and after hours medical facilities. Immigrant mothers need to feel they are getting the right services at the right time to ensure and promote better health outcomes. Identifying the barriers and promoting information about the healthcare system can play an essential role in the appropriate use of health services by immigrant mothers.
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Affiliation(s)
- Sumera Saeed Akhtar
- School of Pharmacy, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Susan Heydon
- School of Pharmacy, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Pauline Norris
- Va'a o Tautai: Centre for Pacific Health, Division of Health Sciences, University of Otago, Dunedin, New Zealand
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6
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Hurst R, Liljenquist K, Lowry SJ, Szilagyi PG, Fiscella KA, Weaver MR, Porras-Javier L, Ortiz J, Sotelo Guerra LJ, Coker TR. A Parent Coach-Led Model of Well-Child Care for Young Children in Low-Income Communities: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e27054. [PMID: 34842563 PMCID: PMC8663704 DOI: 10.2196/27054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 09/22/2021] [Accepted: 09/27/2021] [Indexed: 11/26/2022] Open
Abstract
Background The Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT) intervention was created as a team-based approach to well-child care (WCC) that relies on a health educator (Parent Coach) to provide the bulk of WCC services, address specific needs faced by families in low-income communities, and decrease reliance on the clinician as the primary provider of WCC services. Objective This study aims to evaluate the impact of PARENT using a cluster randomized controlled trial. Methods This study tested the effectiveness of PARENT at 10 clinical sites in 2 federally qualified health centers in Tacoma, Washington, and Los Angeles, California. We conducted a cluster randomized controlled trial that included 916 families with children aged ≤12 months at the time of the baseline survey. Parents will be followed up at 6 and 12 months after enrollment. The Parent Coach, the main element of PARENT, provides anticipatory guidance, psychosocial screening and referral, developmental and behavioral surveillance, screening, and guidance at each WCC visit. The coach is supported by parent-focused previsit screening and visit prioritization, a brief, problem-focused clinician encounter for a physical examination and any concerns that require a clinician’s attention, and an automated text message parent reminder and education service for periodic, age-specific messages to reinforce key health-related information recommended by Bright Futures national guidelines. We will examine parent-reported quality of care (receipt of nationally recommended WCC services, family-centeredness of care, and parental experiences of care), and health care use (WCC, urgent care, emergency department, and hospitalizations), conduct a cost analysis, and conduct a separate time-motion study of clinician time allocation to assess efficiency. We will also collect data on exploratory measures of parent-and parenting-focused outcomes. Our primary outcomes were receipt of anticipatory guidance and emergency department use. Results Participant recruitment began in March 2019. After recruitment, 6- and 12-month follow-up surveys will be completed. As of August 30, 2021, we enrolled a total of 916 participants. Conclusions This large pragmatic trial of PARENT in partnership with federally qualified health centers will assess its utility as an evidence-based and financially sustainable model for the delivery of preventive care services to children in low-income communities. Trial Registration ClinicalTrials.gov: NCT03797898; https://clinicaltrials.gov/ct2/show/NCT03797898 International Registered Report Identifier (IRRID) DERR1-10.2196/27054
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Affiliation(s)
- Rachel Hurst
- School of Public Health, New York University, New York, NY, United States
| | - Kendra Liljenquist
- Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Sarah J Lowry
- Seattle Children's Research Institute, Seattle, WA, United States
| | - Peter G Szilagyi
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kevin A Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, United States
| | - Marcia R Weaver
- Department of Health Metrics Sciences, School of Medicine, University of Washington, Seattle, WA, United States.,Institute for Health Metrics and Evaluation, School of Medicine, University of Washington, Seattle, WA, United States
| | - Lorena Porras-Javier
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, United States
| | - Janette Ortiz
- Department of Pediatrics, University of California, Los Angeles, Los Angeles, CA, United States
| | | | - Tumaini R Coker
- Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
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7
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Ingol TT, Li R, Ronau R, Klebanoff MA, Oza-Frank R, Rausch J, Boone KM, Keim SA. Underdiagnosis of obesity in pediatric clinical care settings among children born preterm: a retrospective cohort study. Int J Obes (Lond) 2021; 45:1717-1727. [PMID: 34002036 PMCID: PMC9681531 DOI: 10.1038/s41366-021-00834-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/19/2021] [Accepted: 04/22/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Neonatal care of preterm infants may include dietary approaches such as high calorie formulas to promote physical growth. However, continuing growth-promoting strategies beyond the point of necessity, coupled with poverty and food insecurity which are more common among families of children born preterm, may increase the risk of obesity. Because children born preterm tend to have more pressing health conditions that require ongoing care, obesity may go undiagnosed by providers. METHODS This retrospective cohort study included 38,849 children (31,548 term, 7301 preterm) born from 2010 to 2015, who received clinical care at a large pediatric medical center (Ohio, USA). Electronic medical record data, linked to Ohio birth certificates, were used to identify children with measured obesity (≥2 weight-for-length values ≥95th percentile before 24 months of age or BMI values ≥95th percentile at or after 24 months of age). Children were considered to have diagnosed obesity if their medical record had an obesity-related phrase or billing code recorded. Modified Poisson regression was used to compare risk of obesity undiagnosis among obese children born preterm versus at term. RESULTS In total, 13,697 children had measured obesity, 10,273 (75%) of which were undiagnosed. Children born preterm with measured obesity were 8% more likely to be undiagnosed compared to children born at term (adjusted relative risk = 1.08 95% CI 1.05, 1.11). The risk was slightly higher for preterm children born to white women or born to women with higher educational attainment. For both groups, Primary Care and subspecialist clinics were the most common settings for undiagnosed obesity (74.9% and 16.8% of undiagnosed cases, respectively). CONCLUSIONS AND RELEVANCE Preterm birth was associated with increased risk of undiagnosed obesity in early childhood. This highlights the need to enhance obesity screening in the preterm population and to further explore reasons for this disparity.
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Affiliation(s)
- Taniqua T. Ingol
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rui Li
- Department of Hematology, College of Medicine, The Ohio State University, Columbus, OH, USA
| | - Rachel Ronau
- Department of Pediatrics, Westchester Medical Center, Valhalla, NY, USA
| | - Mark A. Klebanoff
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA,Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH, USA,Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Reena Oza-Frank
- Obstetrics and Gynecology, College of Medicine, The Ohio State University, Columbus, OH, USA,Ohio Department of Health, Columbus, OH, USA
| | - Joseph Rausch
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA,Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Kelly M. Boone
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
| | - Sarah A. Keim
- Department of Pediatrics, College of Medicine, The Ohio State University, Columbus, OH, USA,Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, USA,Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA
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8
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Peterson JW, Almanzar N, Chamberlain LJ, Huffman L, Butze T, Marin-Nevarez P, Bruce JS. School Readiness Coaching in the Pediatric Clinic: Latinx Parent Perspectives. Acad Pediatr 2021; 21:802-808. [PMID: 33096288 DOI: 10.1016/j.acap.2020.10.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 10/15/2020] [Accepted: 10/17/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Children who enter school developmentally ready for kindergarten are more likely to succeed academically, be healthy and lead productive lives. However, low-income and minority children often enter kindergarten behind their more affluent peers. Pediatric clinics, as trusted family partners, are well positioned to provide school readiness (SR) support. OBJECTIVE To explore Latinx parent perceptions of a clinic-based SR coaching intervention using qualitative methods. Intervention was a 1-hour visit with an SR coach (bilingual community health worker trained to assess child SR, role model SR skills and provide educational tools and community resources). METHODS Qualitative theme analysis of Latinx parent semistructured interviews completed 6 to 9 months after SR coaching intervention (June 2016-February 2017). Parent-child pairs received the SR coaching intervention (N = 74), postintervention interviews (N = 50) were completed, audio recorded, and transcribed. Iterative team-based coding and inductive thematic analysis of interviews were conducted. RESULTS Three domains emerged and included the SR coaching model, community SR resources, and parent SR knowledge. Subthemes included 1) Parents valued the one-to-one SR coaching intervention, were receptive to coach recommendations and believed other parents would benefit from SR coaching; 2) Parents tried new early literacy activities with their child; 3) Despite positive intervention effects, parents lacked a comprehensive understanding of SR. CONCLUSION A brief clinic-based SR coaching intervention with a bilingual SR coach was well received by low-income Latinx parents and increased parent SR behaviors. Expanded implementation and further quantitative evaluation using school entry child-specific data are needed to quantify effects.
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Affiliation(s)
- Jaime W Peterson
- Division of General Pediatrics, Department of Pediatrics, Stanford School of Medicine (JW Peterson, LJ Chamberlin, L Huffman, and JS Bruce), Stanford, Calif.
| | - Nicole Almanzar
- Stanford University (N Almanzar and T Butze), Stanford, Calif
| | - Lisa J Chamberlain
- Division of General Pediatrics, Department of Pediatrics, Stanford School of Medicine (JW Peterson, LJ Chamberlin, L Huffman, and JS Bruce), Stanford, Calif
| | - Lynne Huffman
- Division of General Pediatrics, Department of Pediatrics, Stanford School of Medicine (JW Peterson, LJ Chamberlin, L Huffman, and JS Bruce), Stanford, Calif
| | - Taylor Butze
- Stanford University (N Almanzar and T Butze), Stanford, Calif
| | - Paloma Marin-Nevarez
- Stanford School of Medicine (P Marin-Nevarez), Stanford, Calif. Dr Peterson is now with Division of General Pediatrics, Department of Pediatrics, Oregon Health and Sciences University, Portland, Ore
| | - Janine S Bruce
- Division of General Pediatrics, Department of Pediatrics, Stanford School of Medicine (JW Peterson, LJ Chamberlin, L Huffman, and JS Bruce), Stanford, Calif
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9
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Expert Perspectives on Intimate Partner Violence Power and Control in Pediatric Healthcare Settings. Acad Pediatr 2021; 21:548-556. [PMID: 32097782 DOI: 10.1016/j.acap.2020.02.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/11/2020] [Accepted: 02/15/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Childhood exposure to intimate partner violence (IPV) is a pervasive public health epidemic with profound impact on child health. While past work has demonstrated how abusive partners exert control over IPV survivors in a variety of settings (eg workplace, courts, home), scant research has examined how IPV power and control behaviors manifest themselves in pediatric healthcare settings. In this study, we explore the perspectives of pediatric IPV experts about: (1) behaviors used by abusive partners to control IPV survivors in pediatric healthcare settings; (2) how controlling behaviors impact healthcare access and quality; and (3) recommendations for the pediatric healthcare team. METHODS Individual semi-structured interviews were conducted with pediatric IPV experts recruited through snowball sampling. Interviews were individually coded by two research team members and analyzed using thematic analysis. RESULTS Twenty-eight pediatric IPV experts participated. Participants described several types of controlling behaviors including limiting healthcare access, dominating conversations during medical visits, controlling medical decision making, and manipulating perceptions of the healthcare team. Participants acknowledged the challenges of recognizing controlling behaviors and provided several recommendations to addressing behaviors such as leveraging the expertise of multidisciplinary teams. CONCLUSIONS Participants described how abusive partners may attempt to control or discredit their partners in pediatric healthcare settings, using subtle behaviors that may be easily missed by the healthcare team. These results set the stage for further research and clinical practice innovation including triangulating the findings with IPV survivors, examining how frequently these behaviors occur, and developing multidisciplinary IPV training for the pediatric healthcare team.
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10
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Fenick AM, Leventhal JM, Gilliam W, Rosenthal MS. A Randomized Controlled Trial of Group Well-Child Care: Improved Attendance and Vaccination Timeliness. Clin Pediatr (Phila) 2020; 59:686-691. [PMID: 32107935 DOI: 10.1177/0009922820908582] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Well-child care has suboptimal outcomes regarding adherence to appointments and recall of guidance, especially among families facing structural barriers to health. Group well-child care (GWCC) aims to improve these outcomes by enhancing anticipatory guidance discussions and peer education. We conducted a randomized controlled trial, comparing GWCC with traditional, individual well-child care (IWCC) and assessed health care utilization, immunization timeliness, recall of anticipatory guidance, and family-centered care. Ninety-seven mother-infant dyads were randomized to GWCC or IWCC. Compared with IWCC infants, GWCC infants attended more of the 6 preventive health visits (5.41 vs 4.87, P < .05) and received more timely immunization at 6 months and 1 year but did not differ in emergency or hospital admission rates. There were no differences in mothers' reports of anticipatory guidance received or family-centered care. As primary care is redesigned for value-based care and structural vulnerabilities are considered, GWCC may be a key option to consider.
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11
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Goyal NK, Rohde JF, Short V, Patrick SW, Abatemarco D, Chung EK. Well-Child Care Adherence After Intrauterine Opioid Exposure. Pediatrics 2020; 145:peds.2019-1275. [PMID: 31896548 PMCID: PMC6993495 DOI: 10.1542/peds.2019-1275] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/13/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND AND OBJECTIVES For children with intrauterine opioid exposure (IOE), well-child care (WCC) provides an important opportunity to address medical, developmental, and psychosocial needs. We evaluated WCC adherence for this population. METHODS In this retrospective cohort study, we used PEDSnet data from a pediatric primary care network spanning 3 states from 2011 to 2016. IOE was ascertained by using physician diagnosis codes. WCC adherence in the first year was defined as a postnatal or 1-month visit and completed 2-, 4-, 6-, 9-, and 12-month visits. WCC adherence in the second year was defined as completed 15- and 18-month visits. Gaps in WCC, defined as ≥2 missed consecutive WCC visits, were also evaluated. We used multivariable regression to test the independent effect of IOE status. RESULTS Among 11 334 children, 236 (2.1%) had a diagnosis of IOE. Children with IOE had a median of 6 WCC visits (interquartile range 5-7), vs 8 (interquartile range 6-8) among children who were not exposed (P < .001). IOE was associated with decreased WCC adherence over the first and second years of life (adjusted relative risk 0.54 [P < .001] and 0.74 [P < .001]). WCC gaps were more likely in this population (adjusted relative risk 1.43; P < .001). There were no significant adjusted differences in nonroutine primary care visits, immunizations by age 2, or lead screening. CONCLUSIONS Children <2 years of age with IOE are less likely to adhere to recommended WCC, despite receiving on-time immunizations and lead screening. Further research should be focused on the role of WCC visits to support the complex needs of this population.
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Affiliation(s)
| | - Jessica F. Rohde
- Departments of Pediatrics and,Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Vanessa Short
- Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Stephen W. Patrick
- Division of Neonatology, Departments of Pediatrics and Health Policy and Vanderbilt Center for Child Health Policy, School of Medicine, Vanderbilt University, Nashville, Tennessee; and
| | - Diane Abatemarco
- Obstetrics and Gynecology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Esther K. Chung
- Department of Pediatrics, School of Medicine, University of Washington and Seattle Children’s Hospital, Seattle, Washington
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Schaller J, Schulkind L, Shapiro T. Disease outbreaks, healthcare utilization, and on-time immunization in the first year of life. JOURNAL OF HEALTH ECONOMICS 2019; 67:102212. [PMID: 31323339 DOI: 10.1016/j.jhealeco.2019.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/30/2019] [Accepted: 05/30/2019] [Indexed: 06/10/2023]
Abstract
This paper examines the determinants of parental decisions about infant immunization. Using the exact timing of vaccination relative to birth, we estimate the effects of local pertussis outbreaks occurring in utero and during the first two months of life on the likelihood of on-time initial immunization for pertussis and other diseases. We find that parents respond to changes in perceived disease risk: pertussis outbreaks within a state increase the rate of on-time receipt of the pertussis vaccine at two months of age, particularly among low-socioeconomic status (SES) subgroups. In addition, we find that pertussis outbreaks increase the likelihood of immunization against other vaccine-preventable diseases. Spillover effects in low-SES subgroups are as large as direct effects and are present only for vaccines given during the same visit as the pertussis vaccine, which suggests that provider contact may be a key factor in infant vaccination decisions in poor families.
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Affiliation(s)
- Jessamyn Schaller
- University of Arizona, Eller College of Management, Department of Economics, 1130 E Helen Street Suite 401, Tucson, AZ 85721-0108, United States; Claremont McKenna College, Robert Day School of Economics and Finance, 500 East Ninth Street, Claremont, CA 91711, United States.
| | - Lisa Schulkind
- University of North Carolina at Charlotte, Belk College of Business, Department of Economics, 9201 University City Blvd, Charlotte, NC 28223-0001, United States.
| | - Teny Shapiro
- Slack, Inc., 500 Howard Street, San Francisco, CA 94105, United States.
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Garg P, Eastwood J, Liaw ST. A Realist Synthesis of Literature Informing Programme Theories for Well Child Care in Primary Health Systems of Developed Economies. Int J Integr Care 2019; 19:5. [PMID: 31367204 PMCID: PMC6659757 DOI: 10.5334/ijic.4177] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/10/2019] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Well-child Care is the provision of preventative health care services for children and their families. The approach, however, to the universal provision of those services is contentious. METHODS We undertook a realist synthesis to enhance understanding of the theoretical mechanisms driving Well-child Care by searching for published and grey literature from multiple databases. FINDINGS Well-child Care is re-conceptualised as an integrated program delivered in the continuum of pregnancy, infancy and childhood. Depending on the context, Well-child Care can be a policy, a strategy, or an actual clinical practice that promotes child and family health. The main mechanisms include: role, training and continuity of health providers; administrators' views of the return of investment on achieved outcomes; access to services by families; and the adaptation of programs to meet the dynamic needs of stakeholders. Evidence indicates that for most outcomes, Well-child Care is best delivered in partnerships between community health, social care, and early childhood education sectors. CONCLUSIONS We conclude that Well-child Care policy and program leaders should shift their focus to the integration of: human and physical resources; policy instruments; and shared agreement on outcomes measures across health, social and education sectors. In addition, countries should work towards strengthening universal early education programs and parents' health literacy regarding child development, health and safety.
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Affiliation(s)
- Pankaj Garg
- Department of Community Paediatrics, Liverpool Hospital, Liverpool, NSW, AU
- Specialist Disability Health Team, South Western Sydney Local Health District, NSW, AU
- South Western Sydney Local Health District, NSW, AU
- Ingham Institute of Applied Medical Research, Liverpool, NSW, AU
- School of Women’s and Children’s Health, University of New South Wales (UNSW), AU
| | - John Eastwood
- Ingham Institute of Applied Medical Research, Liverpool, NSW, AU
- School of Women’s and Children’s Health, University of New South Wales (UNSW), AU
- School of Public Health, University of Sydney, Sydney, NSW, AU
- School of Public Health, Griffith University, Gold Coast, QLD, AU
- Department of Community Paediatrics, Sydney Local Health District, Croydon, NSW, AU
- School of Public Health and Community Medicine, UNSW, AU
| | - Siaw-Teng Liaw
- Ingham Institute of Applied Medical Research, Liverpool, NSW, AU
- School of Public Health and Community Medicine, UNSW, AU
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14
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Gullett H, Salib M, Rose J, Stange KC. An Evaluation of CenteringParenting: A Group Well-Child Care Model in an Urban Federally Qualified Community Health Center. J Altern Complement Med 2019; 25:727-732. [DOI: 10.1089/acm.2019.0090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Heidi Gullett
- Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, OH
| | | | - Johnie Rose
- Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Kurt C. Stange
- Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, OH
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Oldfield BJ, Nogelo PF, Vázquez M, Ona Ayala K, Fenick AM, Rosenthal MS. Group Well-Child Care and Health Services Utilization: A Bilingual Qualitative Analysis of Parents’ Perspectives. Matern Child Health J 2019; 23:1482-1488. [DOI: 10.1007/s10995-019-02798-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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16
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Fallon M, Haynes L, Cadet T, Petrosino S, Cazeau E, Solis J, Cox J, Wu AC, Holder-Niles FF. A Group Visit for High-Risk Pediatric Asthma Patients: A Quality Improvement Initiative to Improve Asthma Care. Clin Pediatr (Phila) 2019; 58:746-751. [PMID: 30938184 DOI: 10.1177/0009922819839238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Asthma disproportionately affects poor and minority children. Limited parental knowledge and confidence in asthma management, as well as stress from chronic illness, may contribute to poor outcomes. Novel approaches for providing care are essential for this vulnerable population. Our objective was to evaluate the feasibility and impact of an asthma group visit for high-risk children. METHODS Our primary care practice cares for more than 2600 children with asthma. The majority have public insurance. Children classified as high risk (≥1 asthma-related emergency department visit/hospitalization in the preceding 2 years) were eligible. Children received brief physical examinations, medication review, and updated Asthma Action Plans. Educational sessions were held for children and parents. Pre and post surveys were used to assess parents' experience and changes in confidence in asthma management. RESULTS Twenty children and their parents participated. Mean parent confidence scores (5-point Likert-type scale, 5 indicating greatest confidence) improved in managing their child's asthma symptoms (3.60, 4.40, P ≤ .005), managing their child's asthma medications (3.85, 4.30, P ≤ .005), using their child's Asthma Action Plan (3.79, 4.45, P ≤ .02), communicating with the school about their child's food allergies (4.32, 4.72, P ≤ .03), and helping their child relax to reduce emotional triggers of asthma (3.25, 4.47, P ≤ .01). All families reported that they would return to a group visit. CONCLUSION Group visits are feasible for providing care, education, and peer support to a vulnerable population. Parents expressed satisfaction and improved confidence in aspects of asthma management. Group visits have the potential to improve asthma outcomes for high-risk families.
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Affiliation(s)
- Margaret Fallon
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | - Joanne Cox
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Ann Chen Wu
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA.,3 Center for Healthcare Research in Pediatrics (CHeRP), Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Faye F Holder-Niles
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
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Karimi‐Shahanjarini A, Shakibazadeh E, Rashidian A, Hajimiri K, Glenton C, Noyes J, Lewin S, Laurant M, Colvin CJ. Barriers and facilitators to the implementation of doctor-nurse substitution strategies in primary care: a qualitative evidence synthesis. Cochrane Database Syst Rev 2019; 4:CD010412. [PMID: 30982950 PMCID: PMC6462850 DOI: 10.1002/14651858.cd010412.pub2] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Having nurses take on tasks that are typically conducted by doctors (doctor-nurse substitution, a form of 'task-shifting') may help to address doctor shortages and reduce doctors' workload and human resource costs. A Cochrane Review of effectiveness studies suggested that nurse-led care probably leads to similar healthcare outcomes as care delivered by doctors. This finding highlights the need to explore the factors that affect the implementation of strategies to substitute doctors with nurses in primary care. In our qualitative evidence synthesis (QES), we focused on studies of nurses taking on tasks that are typically conducted by doctors working in primary care, including substituting doctors with nurses or expanding nurses' roles. OBJECTIVES (1) To identify factors influencing implementation of interventions to substitute doctors with nurses in primary care. (2) To explore how our synthesis findings related to, and helped to explain, the findings of the Cochrane intervention review of the effectiveness of substituting doctors with nurses. (3) To identify hypotheses for subgroup analyses for future updates of the Cochrane intervention review. SEARCH METHODS We searched CINAHL and PubMed, contacted experts in the field, scanned the reference lists of relevant studies and conducted forward citation searches for key articles in the Social Science Citation Index and Science Citation Index databases, and 'related article' searches in PubMed. SELECTION CRITERIA We constructed a maximum variation sample (exploring variables such as country level of development, aspects of care covered and the types of participants) from studies that had collected and analysed qualitative data related to the factors influencing implementation of doctor-nurse substitution and the expansion of nurses' tasks in community or primary care worldwide. We included perspectives of doctors, nurses, patients and their families/carers, policymakers, programme managers, other health workers and any others directly involved in or affected by the substitution. We excluded studies that collected data using qualitative methods but did not analyse the data qualitatively. DATA COLLECTION AND ANALYSIS We identified factors influencing implementation of doctor-nurse substitution strategies using a framework thematic synthesis approach. Two review authors independently assessed the methodological strengths and limitations of included studies using a modified Critical Appraisal Skills Programme (CASP) tool. We assessed confidence in the evidence for the QES findings using the GRADE-CERQual approach. We integrated our findings with the evidence from the effectiveness review of doctor-nurse substitution using a matrix model. Finally, we identified hypotheses for subgroup analyses for updates of the review of effectiveness. MAIN RESULTS We included 66 studies (69 papers), 11 from low- or middle-income countries and 55 from high-income countries. These studies found several factors that appeared to influence the implementation of doctor-nurse substitution strategies. The following factors were based on findings that we assessed as moderate or high confidence.Patients in many studies knew little about nurses' roles and the difference between nurse-led and doctor-led care. They also had mixed views about the type of tasks that nurses should deliver. They preferred doctors when the tasks were more 'medical' but accepted nurses for preventive care and follow-ups. Doctors in most studies also preferred that nurses performed only 'non-medical' tasks. Nurses were comfortable with, and believed they were competent to deliver a wide range of tasks, but particularly emphasised tasks that were more health promotive/preventive in nature.Patients in most studies thought that nurses were more easily accessible than doctors. Doctors and nurses also saw nurse-doctor substitution and collaboration as a way of increasing people's access to care, and improving the quality and continuity of care.Nurses thought that close doctor-nurse relationships and doctor's trust in and acceptance of nurses was important for shaping their roles. But nurses working alone sometimes found it difficult to communicate with doctors.Nurses felt they had gained new skills when taking on new tasks. But nurses wanted more and better training. They thought this would increase their skills, job satisfaction and motivation, and would make them more independent.Nurses taking on doctors' tasks saw this as an opportunity to develop personally, to gain more respect and to improve the quality of care they could offer to patients. Better working conditions and financial incentives also motivated nurses to take on new tasks. Doctors valued collaborating with nurses when this reduced their own workload.Doctors and nurses pointed to the importance of having access to resources, such as enough staff, equipment and supplies; good referral systems; experienced leaders; clear roles; and adequate training and supervision. But they often had problems with these issues. They also pointed to the huge number of documents they needed to complete when tasks were moved from doctors to nurses. AUTHORS' CONCLUSIONS Patients, doctors and nurses may accept the use of nurses to deliver services that are usually delivered by doctors. But this is likely to depend on the type of services. Nurses taking on extra tasks want respect and collaboration from doctors; as well as proper resources; good referral systems; experienced leaders; clear roles; and adequate incentives, training and supervision. However, these needs are not always met.
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Affiliation(s)
- Akram Karimi‐Shahanjarini
- Hamadan University of Medical SciencesDepartment of Public HealthMahdeieh Ave. Hamadan, IranHamadanHamadanIran
- Hamadan University of Medical SciencesSocial Determinants of Health Research CenterHamadanIran
| | - Elham Shakibazadeh
- Tehran University of Medical SciencesDepartment of Health Education and Health PromotionTehranTehranIran
| | - Arash Rashidian
- Tehran University of Medical SciencesDepartment of Health Management and Economics, School of Public HealthPoursina AveTehranIran1417613191
| | - Khadijeh Hajimiri
- School of Public Health, Zanjan University of Medical SciencesDepartment of Health Education and Health PromotionZanjanIran
| | - Claire Glenton
- Norwegian Institute of Public HealthPO Box 7004 St Olavs plassOsloNorwayN‐0130
| | - Jane Noyes
- Bangor UniversityCentre for Health‐Related Research, Fron HeulogBangorWalesUKLL57 2EF
| | - Simon Lewin
- Norwegian Institute of Public HealthPO Box 7004 St Olavs plassOsloNorwayN‐0130
- South African Medical Research CouncilHealth Systems Research UnitPO Box 19070TygerbergSouth Africa7505
| | - Miranda Laurant
- Radboud Institute for Health Sciences, IQ healthcareRadboud University Medical CenterPO Box 9101NijmegenNetherlands6500 HB
- Institute of Nursing StudiesHAN University of Applied SciencesNijmegenNetherlands
| | - Christopher J Colvin
- School of Public Health and Family Medicine, University of Cape TownDivision of Social and Behavioural SciencesCape TownSouth Africa
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Jones KA, Do S, Porras-Javier L, Contreras S, Chung PJ, Coker TR. Feasibility and Acceptability in a Community-Partnered Implementation of CenteringParenting for Group Well-Child Care. Acad Pediatr 2018; 18:642-649. [PMID: 29890229 PMCID: PMC10937253 DOI: 10.1016/j.acap.2018.06.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 05/29/2018] [Accepted: 06/02/2018] [Indexed: 10/14/2022]
Abstract
BACKGROUND In a community-academic partnership, we implemented a group-based model for well-child care (WCC) (CenteringParenting) and conducted a pilot test for feasibility and acceptability among families at a federally qualified health center (FQHC). METHODS The FQHC implemented CenteringParenting for all WCC visits in the first year of life, starting at the 2-week visit. Over a 14-month time period, parents from each new CenteringParenting group were enrolled into the study. Baseline data were collected at enrollment (infant age < 31 days) and again at a 6-month follow-up survey. Main outcomes were feasibility and acceptability of CenteringParenting; we also collected exploratory measures (parent experiences of care, utilization, self-efficacy, and social support). RESULTS Of the 40 parent-infant dyads enrolled in the pilot, 28 CenteringParenting participants completed the 6-month follow-up assessment. The majority of infants were Latino, black, or "other" race/ethnicity; over 90% were Medicaid insured. Of the 28 CenteringParenting participants who completed the 6-month follow-up, 25 completed all visits between ages 2 weeks and 6 months in the CenteringParenting group. Of the CenteringParenting participants, 97% to 100% reported having adequate time with their provider and sufficient patient education and having their needs met at visits; most reported feeling comfortable at the group visit, and all reported wanting to continue CenteringParenting for their WCC. CenteringParenting participants' mean scores on exploratory measures demonstrated positive experiences of care, overall satisfaction of care, confidence in parenting, and parental social support. CONCLUSIONS A community-academic partnership implemented CenteringParenting; the intervention was acceptable and feasible for a minority, low-income population. We highlight key challenges of implementation.
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Affiliation(s)
- Kai A Jones
- Columbia University College of Physicians and Surgeons, New York, NY
| | | | | | | | - Paul J Chung
- Mattel Children's Hospital UCLA, David Geffen School of Medicine at UCLA; UCLA Fielding School of Public Health, Los Angeles, Calif
| | - Tumaini R Coker
- University of Washington School of Medicine, Seattle Children's Research Institute, Seattle, Wash.
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Ragavan MI, Li W, Elwy AR, Cowden JD, Bair-Merritt M. Chinese, Vietnamese, and Asian Indian Parents' Perspectives About Well-Child Visits: A Qualitative Analysis. Acad Pediatr 2018; 18:628-635. [PMID: 29157598 DOI: 10.1016/j.acap.2017.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/04/2017] [Accepted: 11/12/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Well-child visits are a critical component of pediatric health care; however, disparities in attendance and quality of care exist for Asian children. Limited research has explored Asian immigrant parents' perspectives about their well-child visit experience. METHODS Qualitative interviews were conducted with Chinese, Vietnamese, and Asian Indian immigrant parents. Participants were recruited from community-based organizations in the Boston area. Interviews focused on parents' perceptions about well-child visits, including individual attitudes, social and cultural factors affecting their opinions, perceived behavioral control, and improving visits for Asian immigrant families. Data were coded and analyzed using thematic analysis. RESULTS Fifty-one parents participated. Although participants reported attending well-child visits, they thought language barriers and unfamiliarity with US preventive health care may limit attendance for other Asian immigrant families. Some reported high-quality visits, while others described them as "too simple," recollecting health care experiences from their countries of origin where more tests were completed. Participants described seeking advice about their children's preventive care from elder family members. Many expressed the importance of culturally concordant health care providers and culturally sensitive care, while others thought that culture was less relevant. Differences emerged among the 3 subgroups around culturally concordant care and traditional medicine. CONCLUSIONS Querying parents about their past health care experiences and providing information about well-child visits may be useful when caring for immigrant families. Social influences on children's health outside of the parent-provider-child triad may also be important. Further work should explore how to deliver culturally sensitive care that considers not only a family's language preferences but also their unique cultural identity.
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Affiliation(s)
- Maya I Ragavan
- Department of Pediatrics, Boston Medical Center, Boston, Mass.
| | - Wendy Li
- Boston University School of Public Health, Boston, Mass
| | - A Rani Elwy
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, Jamaica Plain, Mass; Boston University School of Public Health, Boston, Mass
| | - John D Cowden
- Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Mo
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20
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Freeman BK, Coker TR. Six Questions for Well-Child Care Redesign. Acad Pediatr 2018; 18:609-619. [PMID: 29857062 DOI: 10.1016/j.acap.2018.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 05/02/2018] [Accepted: 05/11/2018] [Indexed: 02/07/2023]
Abstract
In the United States, well-child care has the goal of providing comprehensive care to children by addressing developmental, behavioral, psychosocial, and health issues through visits at recommended intervals. The preventive care needs of families can outpace the capacity of clinics and practices to provide it, necessitating a redesign of our well-child care system that aligns the structure of preventive care delivery with the needs of families. Here we focus on 6 questions (the what, when, who, why, how, and where) for well-child care redesign for infants and young children. By addressing these key questions and providing recommendations for advancing well-child care redesign in the clinical and research arenas, we hope to accelerate the process of well-child care redesign. In the current political and socioeconomic environment, continuing with well-child care "as usual" will mean that many families will find that their well-child care visits do not fully address the most pressing needs impacting children's health and well-being. It is time to implement and sustain real change in our system for preventive care.
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Affiliation(s)
- Brandi K Freeman
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colo (Dr Freeman)
| | - Tumaini R Coker
- Department of Pediatrics, University of Washington School of Medicine, Center for Diversity and Health Equity, Seattle Children's Hospital, and Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, Wash (Dr Coker)
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Connor KA, Duran G, Faiz-Nassar M, Mmari K, Minkovitz CS. Feasibility of Implementing Group Well Baby/Well Woman Dyad Care at Federally Qualified Health Centers. Acad Pediatr 2018; 18:510-515. [PMID: 28919481 DOI: 10.1016/j.acap.2017.09.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 09/08/2017] [Accepted: 09/10/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Group care has been shown to be effective for delivery of infant well child care. Centering Parenting (CP) is a model of group dyad care for mothers and infants. CP might improve quality and efficiency of preventive care, particularly for low-income families. Federally qualified health centers (FQHCs) might be optimal sites for implementation, however, facilitators and barriers might be unique. The aim of this qualitative study was to assess stakeholder perspectives on the feasibility of implementing CP in FQHCs in Baltimore. METHODS Semistructured interviews were conducted with mothers, clinicians, staff, and administrators recruited from 2 FQHCs using purposive sampling. Interviews were recorded, transcribed verbatim, and uploaded to Atlas.ti version 7.0 (Atlas.ti Scientific Software Development, GmbH Berlin, Germany) for analysis. Using an inductive thematic analysis approach, 2 investigators coded the transcripts. Matrices of key codes were developed to identify themes and patterns across stakeholder groups. RESULTS Interviews were completed with 26 mothers and 16 clinicians, staff, and administrators. Most participants considered CP desirable. Facilitators included: peer support and education, emphasis on maternal wellness, and increased patient and clinician satisfaction. Barriers included: exposure to "others," scheduling and coordination of care, productivity, training requirements, and cost. Parenting experience did not appear to affect perspectives on CP. CONCLUSIONS Perceptions regarding facilitators and barriers to CP implementation in FQHCs are similar to existing group well-child care literature. The benefit of emphasis on maternal wellness is a unique finding. Maternal wellness integration might make CP a particularly desirable model for implementation at FQHCs, but potential systems barriers must be addressed.
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Affiliation(s)
- Katherine A Connor
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Md; Department of Populations, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md.
| | - Gabriela Duran
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Mariam Faiz-Nassar
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Md
| | - Kristin Mmari
- Department of Populations, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
| | - Cynthia S Minkovitz
- Department of Pediatrics, Division of General Pediatrics and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, Md; Department of Populations, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Md
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22
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Goyal NK, Folger AT, Sucharew HJ, Brown CM, Hall ES, Van Ginkel JB, Ammerman RT. Primary Care and Home Visiting Utilization Patterns among At-Risk Infants. J Pediatr 2018; 198:240-246.e2. [PMID: 29731356 DOI: 10.1016/j.jpeds.2018.03.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 02/15/2018] [Accepted: 03/07/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe well child care (WCC) utilization in the first year of life among at-risk infants, and the relationship to home visiting enrollment. STUDY DESIGN Retrospective cohort study using linked administrative data for infants ≥34 weeks' gestation from 2010 to 2014, within a regional, academic primary care system. Association between WCC visits and home visiting enrollment was evaluated using bivariate comparisons and multivariable Poisson regression. Latent class analysis further characterized longitudinal patterns of WCC attendance. Multivariable logistic regression tested the association between home visiting and pattern of timeliest adherence to recommended WCC. RESULTS Of 11 936 infants, mean number of WCC visits was 4.1 in the first 12 months of life. Of 3910 infants eligible for home visiting, 28.5% were enrolled. Among enrolled infants, mean WCC visits was 4.7 vs 4.4 among eligible, nonenrolled infants, P value < .001. After multivariable adjustment, there was no significant association between enrollment and WCC visit count (adjusted incident rate ratio 1.03, 95% CI 0.99, 1.07). Using latent class analysis, 3 WCC classes were identified: infants in class 1 (77.7%) were most adherent to recommended WCC, class 2 (12.5% of cohort) had progressively declining WCC attendance over the first year of life, and class 3 (9.8%) maintained moderate attendance. In multivariable regression, home visiting was associated with class 1 membership, aOR 1.27, 95% CI 1.04, 1.57. CONCLUSIONS A pattern of timely WCC attendance was more likely among infants in home visiting; however, most infants eligible for home visiting were not enrolled.
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Affiliation(s)
- Neera K Goyal
- Department of Pediatrics, Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA; Division of General Pediatrics, Nemours/AI duPont Hospital for Children, Wilmington, DE.
| | - Alonzo T Folger
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Heidi J Sucharew
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Courtney M Brown
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of General Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Eric S Hall
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Judith B Van Ginkel
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Robert T Ammerman
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Low-Income Women's Feeding Practices and Perceptions of Dietary Guidance: A Qualitative Study. Matern Child Health J 2018; 20:2510-2517. [PMID: 27465059 DOI: 10.1007/s10995-016-2076-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Objectives Describe themes characterizing feeding behaviors of low-income women participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and identify the attitudes, beliefs, and sources of information that inform these practices. Methods Formative research was conducted including focus groups and semi-structured individual phone interviews with a total of 68 low-income women participating in WIC. Qualitative data were recorded, transcribed, imported into NVivo 8.0, and analyzed for common themes. Results Mothers reported feeding behaviors inconsistent with guidance from WIC and the American Academy of Pediatrics. Three main themes were identified. First, mothers reported receiving conflicting messaging/advice from medical professionals, WIC nutritionists, and family members, which was confusing. Mothers also reported dissatisfaction with the "one size fits most" approach. Lastly, mothers reported relying on their "instincts" and that "all babies are different" when deciding and rationalizing what feeding guidance to follow. Conclusions Future interventions targeting this high-risk population should consider developing personalized (individualized) messaging, tailored to the needs of each mother-child dyad. Focused efforts are needed to build partnerships between WIC providers and other health care providers to provide more consistent messages about responsive feeding to prevent early obesity.
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Arthur KC, Lucenko BA, Sharkova IV, Xing J, Mangione-Smith R. Using State Administrative Data to Identify Social Complexity Risk Factors for Children. Ann Fam Med 2018; 16:62-69. [PMID: 29311178 PMCID: PMC5758323 DOI: 10.1370/afm.2134] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 04/25/2017] [Accepted: 06/14/2017] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Screening for social determinants of health is challenging but critically important for optimizing child health outcomes. We aimed to test the feasibility of using an integrated state agency administrative database to identify social complexity risk factors and examined their relationship to emergency department (ED) use. METHODS We conducted a retrospective cohort study among children younger than 18 years with Washington State Medicaid insurance coverage (N = 505,367). We linked child and parent administrative data for this cohort to identify a set of social complexity risk factors, such as poverty and parent mental illness, that have either a known or hypothesized association with suboptimal health care use. Using multivariate analyses, we examined associations of each risk factor and of number of risk factors with the rate of ED use. RESULTS Nine of 11 identifiable social complexity risk factors were associated with a higher rate of ED use. Additionally, the rate increased as the number of risk factors increased from 0 to 5 or more, reaching approximately twice the rate when 5 or more risk factors were present in children aged younger than 5 years (incidence rate ratio = 1.92; 95% CI, 1.85-2.00) and in children aged 5 to 17 years (incidence rate ratio = 2.06; 95% CI, 1.99-2.14). CONCLUSIONS State administrative data can be used to identify social complexity risk factors associated with higher rates of ED use among Medicaid-insured children. State agencies could give primary care medical homes a social risk flag or score to facilitate targeted screening and identification of needed resources, potentially preventing future unnecessary ED use in this vulnerable population of children.
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Affiliation(s)
| | - Barbara A Lucenko
- Washington State Department of Social and Health Services, Division of Research and Data Analysis, Olympia, Washington
| | - Irina V Sharkova
- Washington State Department of Social and Health Services, Division of Research and Data Analysis, Olympia, Washington
| | - Jingping Xing
- Washington State Department of Social and Health Services, Division of Research and Data Analysis, Olympia, Washington
| | - Rita Mangione-Smith
- Seattle Children's Research Institute, Seattle, Washington.,University of Washington Department of Pediatrics, Seattle, Washington
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Real FJ, Michelson CD, Beck AF, Klein MD. Location, Location, Location: Teaching About Neighborhoods in Pediatrics. Acad Pediatr 2017; 17:228-232. [PMID: 27988207 PMCID: PMC5498986 DOI: 10.1016/j.acap.2016.12.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 12/08/2016] [Indexed: 10/20/2022]
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26
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Factors That Matter to Low-Income and Racial/Ethnic Minority Mothers When Choosing a Pediatric Practice: a Mixed Methods Analysis. J Racial Ethn Health Disparities 2017; 4:1051-1060. [PMID: 28275998 DOI: 10.1007/s40615-016-0309-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 11/07/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Pediatric practices' scores on healthcare quality measures are increasingly available to the public. However, patients from low-income and racial/ethnic minority populations rarely use these data. We sought to understand potential barriers to using quality data by assessing what factors mattered to women when choosing a pediatric practice. METHODS As part of a randomized trial to overcome barriers to using quality data, we recruited women from a prenatal clinic serving an underserved population. Women reported how much 12 factors mattered when they chose a pediatric practice (5-point Likert scale), what other factors mattered to them, and which factors mattered the most. We assessed whether factor importance varied with selected participant characteristics and qualitatively analyzed the "other" factors named. RESULTS Participants' (n = 367) median age was 23 years, and they were largely Hispanic (60.4%), white (21.2%), or black (16.9%). Insurance acceptance "mattered a lot" to the highest percentage of women (93.2%), while online information about what other parents think of a practice "mattered a lot" to the fewest (7.4%). Major themes from our qualitative analysis of "other" factors that mattered included physicians' interpersonal skills and pediatrician-specific traits. Factors related to access "mattered the most" to the majority of women. CONCLUSIONS Pediatrician characteristics and factors related to access to care may be more important to low-income and racial/ethnic minority women than more commonly reported quality metrics. Aligning both the content and delivery of publicly reported quality data with women's interests may increase use of pediatric quality data. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov NCT01784575.
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Mimila NA, Chung PJ, Elliott MN, Bethell CD, Chacon S, Biely C, Contreras S, Chavis T, Bruno Y, Moss T, Coker TR. Well-Child Care Redesign: A Mixed Methods Analysis of Parent Experiences in the PARENT Trial. Acad Pediatr 2017; 17:747-754. [PMID: 28232142 PMCID: PMC5555836 DOI: 10.1016/j.acap.2017.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 01/23/2017] [Accepted: 02/03/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT), is a well-child care (WCC) model that has demonstrated effectiveness in improving the receipt of comprehensive WCC services and reducing emergency department utilization for children aged 0 to 3 in low-income communities. PARENT relies on a health educator ("parent coach") to provide WCC services; it utilizes a Web-based previsit prioritization/screening tool (Well-Visit Planner) and an automated text message reminder/education service. We sought to assess intervention feasibility and acceptability among PARENT trial intervention participants. METHODS Intervention parents completed a survey after a 12-month study period; a 26% random sample of them were invited to participate in a qualitative interview. Interviews were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis; survey responses were analyzed using bivariate methods. RESULTS A total of 115 intervention participants completed the 12-month survey; 30 completed a qualitative interview. Nearly all intervention participants reported meeting with the coach, found her helpful, and would recommend continuing coach-led well visits (97-99%). Parents built trusting relationships with the coach and viewed her as a distinct and important part of their WCC team. They reported that PARENT well visits more efficiently used in-clinic time and were comprehensive and family centered. Most used the Well-Visit Planner (87%), and found it easy to use (94%); a minority completed it at home before the visit (18%). Sixty-two percent reported using the text message service; most reported it as a helpful source of new information and a reinforcement of information discussed during visits. CONCLUSIONS A parent coach-led intervention for WCC for young children is a model of WCC delivery that is both acceptable and feasible to parents in a low-income urban population.
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Affiliation(s)
- Naomi A. Mimila
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Paul J. Chung
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA,RAND, Santa Monica, CA,UCLA Fielding School of Public Health, Los Angeles, CA
| | | | | | - Sandra Chacon
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Christopher Biely
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Sandra Contreras
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | | | | | - Tanesha Moss
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Tumaini R. Coker
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, CA,RAND, Santa Monica, CA
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A Voice and a Vote: The Advisory Board Experiences of Spanish-Speaking Latina Mothers. HISPANIC HEALTH CARE INTERNATIONAL 2016; 13:217-26. [PMID: 26671562 DOI: 10.1891/1540-4153.13.4.217] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Latino children experience disparities in health care access and quality. Family advisory groups for clinics and hospitals may be one way to address disparities. We implemented and sustained an advisory board whose parent participants were exclusively limited-English proficient Latina mothers. As part of the board evaluation, we conducted semistructured individual interviews with parent participants during initial participation and after the final board meeting of the year. Members were satisfied with their board participation in both initial and follow-up interviews. They reported that board membership was an important way to improve clinic services and a unique opportunity for Latinos in the community. Experiences of discrimination and marginalization in health care settings were a theme across interviews. Members reported board membership countered these negative experiences. An advisory board including Spanish-speaking parents is an opportunity to engage vulnerable populations, which may result in broader impact on health care disparities.
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Goyal NK, Hall ES, Kahn RS, Wexelblatt SL, Greenberg JM, Samaan ZM, Brown CM. Care Coordination Associated with Improved Timing of Newborn Primary Care Visits. Matern Child Health J 2016; 20:1923-32. [DOI: 10.1007/s10995-016-2006-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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30
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Goyal NK, Ammerman RT, Massie JA, Clark M, Van Ginkel JB. Using quality improvement to promote implementation and increase well child visits in home visiting. CHILD ABUSE & NEGLECT 2016; 53:108-117. [PMID: 26699456 DOI: 10.1016/j.chiabu.2015.11.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 11/16/2015] [Accepted: 11/18/2015] [Indexed: 06/05/2023]
Abstract
A key goal of home visiting is to connect children with medical homes through anticipatory guidance regarding recommended well child care (WCC). Substantial barriers to WCC among low socioeconomic families can limit achievement of this outcome. Quality improvement strategies have been widely adopted in healthcare but only recently implemented in home visiting to achieve program outcomes. The objective of this initiative was to increase the percentage of infants enrolled in home visiting who completed at least 3 recommended WCC visits in the first 6 months of life within a large, multi-model program comprised of 11 sites. A series of 33 quality improvement cycles were conducted at 3 sites involving 18 home visitors and 139 families with infants in the target age range. These were deployed sequentially, and changes within and across sites were monitored using trend charts over time. Adopted strategies were then implemented program-wide. Initiatives focused on staff training in WCC recommendations, data collection processes, monthly family tracking reports, and enhanced communication with primary care offices. Data were shared in iterative sessions to identify methods for improving adherence. Wide baseline variability across sites was observed, with the percentage of infants with recommended care ranging from 35% to 83%. Over the project timeline, the percentage of infants receiving at least 3 WCC visits in the first 6 months increased from 58% to 86%. Quality improvement within home visiting can be used to improve WCC adherence and provides an example of maximizing implementation of home visiting interventions.
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Affiliation(s)
- Neera K Goyal
- Division of Neonatology and Pulmonary Biology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Robert T Ammerman
- Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Julie A Massie
- James M. Anderson Center for Health Systems Excellence at the Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Margaret Clark
- United Way of Greater Cincinnati, 2400 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Judith B Van Ginkel
- Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
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Coker TR, Chacon S, Elliott MN, Bruno Y, Chavis T, Biely C, Bethell CD, Contreras S, Mimila NA, Mercado J, Chung PJ. A Parent Coach Model for Well-Child Care Among Low-Income Children: A Randomized Controlled Trial. Pediatrics 2016; 137:e20153013. [PMID: 26908675 PMCID: PMC4771128 DOI: 10.1542/peds.2015-3013] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The goal of this study was to examine the effects of a new model for well-child care (WCC), the Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT), on WCC quality and health care utilization among low-income families. METHODS PARENT includes 4 elements designed by using a stakeholder-engaged process: (1) a parent coach (ie, health educator) to provide anticipatory guidance, psychosocial screening and referral, and developmental/behavioral guidance and screening at each well-visit; (2) a Web-based tool for previsit screening; (3) an automated text message service to provide periodic, age-specific health messages to families; and (4) a brief, problem-focused encounter with the pediatric clinician. The Promoting Healthy Development Survey-PLUS was used to assess receipt of recommended WCC services at 12 months' postenrollment. Intervention effects were examined by using bivariate analyses. RESULTS A total of 251 parents with a child aged ≤12 months were randomized to receive either the control (usual WCC) or the intervention (PARENT); 90% completed the 12-month assessment. Mean child age at enrollment was 4.5 months; 64% had an annual household income less than $20,000. Baseline characteristics for the intervention and control groups were similar. Intervention parents scored higher on all preventive care measures (anticipatory guidance, health information, psychosocial assessment, developmental screening, and parental developmental/behavioral concerns addressed) and experiences of care measures (family-centeredness, helpfulness, and overall rating of care). Fifty-two percent fewer intervention children had ≥2 emergency department visits over the 12-month period. There were no significant differences in WCC or sick visits/urgent care utilization. CONCLUSIONS A parent coach-led model for WCC may improve the receipt of comprehensive WCC for low-income families, and it may potentially lead to cost savings by reducing emergency department utilization.
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Affiliation(s)
- Tumaini R. Coker
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California;,RAND, Santa Monica, California
| | - Sandra Chacon
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | | | | | - Christopher Biely
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Sandra Contreras
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Naomi A. Mimila
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Jeffrey Mercado
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California
| | - Paul J. Chung
- UCLA Children’s Discovery & Innovation Institute, Mattel Children’s Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California;,RAND, Santa Monica, California;,UCLA Fielding School of Public Health, Los Angeles, California
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Noyes J, Hendry M, Lewin S, Glenton C, Chandler J, Rashidian A. Qualitative "trial-sibling" studies and "unrelated" qualitative studies contributed to complex intervention reviews. J Clin Epidemiol 2016; 74:133-43. [PMID: 26775628 DOI: 10.1016/j.jclinepi.2016.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 12/23/2015] [Accepted: 01/06/2016] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the contribution of "trial-sibling" and "unrelated" qualitative studies in complex intervention reviews. STUDY DESIGN AND SETTING Researchers are using qualitative "trial-sibling" studies undertaken alongside trials to provide explanations to understand complex interventions. In the absence of qualitative "trial-sibling" studies, it is not known if qualitative studies "unrelated" to trials are helpful. Trials, "trial-sibling," and "unrelated" qualitative studies looking at three health system interventions were identified. We looked for similarities and differences between the two types of qualitative studies, such as participants, intervention delivery, context, study quality and reporting, and contribution to understanding trial results. RESULTS Reporting was generally poor in both qualitative study types. We detected no substantial differences in participant characteristics. Interventions in qualitative "trial-sibling" studies were delivered using standardized protocols, whereas interventions in "unrelated" qualitative studies were delivered in routine care. Qualitative "trial-sibling" studies alone provided insufficient data to develop meaningful transferrable explanations beyond the trial context, and their limited focus on immediate implementation did not address all phenomena of interest. Together, "trial-sibling" and "unrelated" qualitative studies provided larger, richer data sets across contexts to better understand the phenomena of interest. CONCLUSIONS Findings support inclusion of "trial-sibling" and "unrelated" qualitative studies to explore complexity in complex intervention reviews.
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Affiliation(s)
- Jane Noyes
- School of Social Sciences, Bangor University, Bangor, LL57 2EF, UK.
| | - Margaret Hendry
- North Wales Centre for Primary Care Research, Bangor University, Gwenfro Units 4-8, Wrexham Technology Park, Wrexham LL13 7YP, UK
| | - Simon Lewin
- Global Health Unit, Norwegian Knowledge Centre, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway; Health Systems Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape, PO Box 190707505 Tygerberg, South Africa
| | - Claire Glenton
- Global Health Unit, Norwegian Knowledge Centre, Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway
| | - Jackie Chandler
- The Cochrane Editorial Unit, Cochrane Central Executive, St Albans House, 57-59 Haymarket, London SW1Y 4QX, UK
| | - Arash Rashidian
- Department of Health Management and Economics, Tehran University of Medical Science, Tehran, Iran
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Zickafoose JS, DeCamp LR, Prosser LA. Parents' preferences for enhanced access in the pediatric medical home: a discrete choice experiment. JAMA Pediatr 2015; 169:358-64. [PMID: 25643000 PMCID: PMC4545238 DOI: 10.1001/jamapediatrics.2014.3534] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Efforts to transform primary care through the medical home model may have limited effectiveness if they do not incorporate families' preferences for different primary care services. OBJECTIVE To assess parents' relative preferences for different categories of enhanced access services in primary care. DESIGN, SETTING, AND PARTICIPANTS Internet-based survey that took place with a national online panel from December 8, 2011, to December 22, 2011. Participants included 820 parents of children aged 0 to 17 years. Hispanic and black non-Hispanic parents were each oversampled to 20% of the sample. The survey included a discrete choice experiment with questions that asked parents to choose between hypothetical primary care practices with different levels of enhanced access and other primary care services. MAIN OUTCOMES AND MEASURES We estimated parents' relative preferences for different enhanced access services using travel time to the practice as a trade-off and parents' marginal willingness to travel in minutes for practices with different levels of services. RESULTS The response rate of parents who participated in the study was 41.2%. Parents were most likely to choose primary care offices that guaranteed same-day sick visits (coefficient, 0.57 [SE, 0.05]; P < .001) followed by those with higher professional continuity (coefficient, 0.36 [SE, 0.03]; P < .001). Parents were also significantly more likely to choose practices with 24-hour telephone advice plus nonurgent email advice (0.08 [0.04]; P < .05), evening hours 4 or more times a week (0.14 [0.04]; P < .001), and at least some hours on weekends. Parents were significantly less likely to choose practices that were closed during some weekday daytime hours or had wait times longer than 4 weeks for preventive care visits. There was very little variation in preferences among parents with different sociodemographic characteristics. Parents' marginal willingness to travel was 14 minutes (95% CI, 11-16 minutes) for guaranteed same-day sick visits and 44 minutes (95% CI, 37-51 minutes) for an office with idealized levels of all services. CONCLUSIONS AND RELEVANCE As primary care practices for children implement aspects of the medical home model, those that emphasize same-day sick care and professional continuity are more likely to meet parents' preferences for enhanced access. Practices should seek to engage families in prioritizing changes in practice services as part of medical home implementation.
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Affiliation(s)
- Joseph S. Zickafoose
- Mathematica Policy Research, Ann Arbor, Michigan3Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor
| | - Lisa R. DeCamp
- Division of General Pediatrics, Johns Hopkins University, Baltimore, Maryland
| | - Lisa A. Prosser
- Child Health Evaluation and Research (CHEAR) Unit, Division of General Pediatrics, University of Michigan, Ann Arbor
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Vasan A, Solomon BS. Use of colocated multidisciplinary services to address family psychosocial needs at an urban pediatric primary care clinic. Clin Pediatr (Phila) 2015; 54:25-32. [PMID: 25009114 DOI: 10.1177/0009922814541802] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To examine associations between use of on-site multidisciplinary services at a pediatric primary care clinic, perceptions of the clinic, and health care utilization. STUDY DESIGN Eighty caregivers were interviewed during clinic visits assessing on-site service use, satisfaction, and perception of the clinic as a medical home. Acute care, emergency department, and well-child visit data were abstracted from children's medical records. Student's t test and multivariate regression were used to examine associations between service use, satisfaction, and health care utilization. RESULTS Use of ≥3 clinic services was associated with improved satisfaction (Client Satisfaction Questionnaire-8 mean: 31.8 vs 31.0, P < .05), stronger perception of the clinic as a medical home (Parents' Perception of Primary Care mean: 97.6 vs 93.4, P < .01), and increased missed well-child care visits (mean: 0.49 vs 0.20, P < .05). CONCLUSIONS On-site service use was associated with improved caregiver satisfaction but decreased well-child visit adherence. Caregivers using support services may face barriers to accessing preventive care.
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Affiliation(s)
- Aditi Vasan
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Barry S Solomon
- Johns Hopkins University School of Medicine, Baltimore, MD, USA Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Coker TR, Moreno C, Shekelle PG, Schuster MA, Chung PJ. Well-child care clinical practice redesign for serving low-income children. Pediatrics 2014; 134:e229-39. [PMID: 24936004 PMCID: PMC4067638 DOI: 10.1542/peds.2013-3775] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Our objective was to conduct a rigorous, structured process to create a new model of well-child care (WCC) in collaboration with a multisite community health center and 2 small, independent practices serving predominantly Medicaid-insured children. Working groups of clinicians, staff, and parents (called "Community Advisory Boards" [CABs]) used (1) perspectives of WCC stakeholders and (2) a literature review of WCC practice redesign to create 4 comprehensive WCC models for children ages 0 to 3 years. An expert panel, following a modified version of the Rand/UCLA Appropriateness Method, rated each model for potential effectiveness on 4 domains: (1) receipt of recommended services, (2) family-centeredness, (3) timely and appropriate follow-up, and (4) feasibility and efficiency. Results were provided to the CABs for selection of a final model to implement. The newly developed models rely heavily on a health educator for anticipatory guidance and developmental, behavioral, and psychosocial surveillance and screening. Each model allots a small amount of time with the pediatrician to perform a brief physical examination and to address parents' physical health concerns. A secure Web-based tool customizes the visit to parents' needs and facilitates previsit screening. Scheduled, non-face-to-face methods (text, phone) for parent communication with the health care team are also critical to these new models of care. A structured process that engages small community practices and community health centers in clinical practice redesign can produce comprehensive, site-specific, and innovative models for delivery of WCC. This process, as well as the models developed, may be applicable to other small practices and clinics interested in practice redesign.
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Affiliation(s)
- Tumaini R. Coker
- UCLA Children’s Discovery and Innovation Institute, Mattel Children’s Hospital, and,RAND, Santa Monica, California
| | - Candice Moreno
- University of Illinois College of Medicine, Chicago, Illinois
| | - Paul G. Shekelle
- Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California;,RAND, Santa Monica, California;,Department of Internal Medicine, West Los Angeles VA Hospital, Los Angeles, California
| | - Mark A. Schuster
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Massachusetts;,Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and
| | - Paul J. Chung
- UCLA Children’s Discovery and Innovation Institute, Mattel Children’s Hospital, and,RAND, Santa Monica, California;,Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
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Mooney K, Moreno C, Chung PJ, Elijah J, Coker TR. Well-child care clinical practice redesign at a community health center: provider and staff perspectives. J Prim Care Community Health 2013; 5:19-23. [PMID: 24327599 DOI: 10.1177/2150131913511641] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Community health centers (CHCs) are a key element of the health care safety net for underserved children. They may be an ideal setting to create well-child care (WCC) clinical practice redesign to drastically improve WCC delivery. OBJECTIVE To examine the perspectives of clinical and administrative staff at a large, multisite urban CHC on alternative ways to deliver WCC services for low-income children aged 0 to 3 years. METHODS Eight semistructured interviews were conducted with 4 pediatric teams (each consisting of 1 pediatrician and 2 medical assistants) and 4 CHC executive/administrative staff (Medical Director, COO, CEO, and Nurse Supervisor). Discussions were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis. Salient themes included WCC delivery challenges and endorsed WCC clinical practice redesign solutions. RESULTS The 3 main WCC delivery challenges included long wait times due to insurance verification and intake paperwork, lack of time for parent education and sick visits due to WCC visit volume, and absence of a system to encourage physicians to use non-face-to-face communication with parents. To address WCC delivery challenges, CHC providers and administrators endorsed several options for clinical practice redesign in their setting. These included use of a health educator in a team-based model of care, a previsit tool for screening and surveillance, Web site health education, a structured system for non-face-to-face (eg, phone) parent communication, and group visits. CONCLUSION CHC-specific strategies for WCC clinical practice redesign endorsed by a large, multisite safety net clinic may lead to more efficient, effective, and family-centered WCC for low-income populations.
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Affiliation(s)
- Kelly Mooney
- David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Zickafoose JS, DeCamp LR, Prosser LA. Association between enhanced access services in pediatric primary care and utilization of emergency departments: a national parent survey. J Pediatr 2013; 163:1389-95.e1-6. [PMID: 23759421 PMCID: PMC3796049 DOI: 10.1016/j.jpeds.2013.04.050] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 04/01/2013] [Accepted: 04/24/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To measure the prevalence of enhanced access services in pediatric primary care and to assess whether enhanced access services are associated with lower emergency department (ED) utilization. STUDY DESIGN Internet-based survey of a national sample of parents (n = 820, response rate 41%). We estimated the prevalence of reported enhanced access services and ED use in the prior 12 months. We then used multivariable negative binomial regression to assess associations between enhanced access services and ED use. RESULTS The majority of parents reported access to advice by telephone during office hours (80%), same-day sick visits (79%), and advice by telephone outside office hours (54%). Less than one-half of parents reported access to their child's primary care office on weekends (47%), after 5:00 p.m. on any night (23%), or by email (13%). Substantial proportions of parents reported that they did not know if these services were available (7%-56%, depending on service). Office hours after 5:00 p.m. on ≥ 5 nights a week was the only service significantly associated with ED utilization in multivariable analysis (adjusted incidence rate ratio: 0.51 [95% CI 0.28-0.92]). CONCLUSIONS The majority of parents report enhanced access to their child's primary care office during office hours, but many parents do not have access or do not know if they have access outside of regular office hours. Extended office hours may be the most effective practice change to reduce ED use. Primary care practices should prioritize the most effective enhanced access services and communicate existing services to families.
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Affiliation(s)
- Joseph S Zickafoose
- Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, MI; Mathematica Policy Research, Ann Arbor, MI.
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DeCamp LR, Kieffer E, Zickafoose JS, DeMonner S, Valbuena F, Davis MM, Heisler M. The voices of limited English proficiency Latina mothers on pediatric primary care: lessons for the medical home. Matern Child Health J 2013; 17:95-109. [PMID: 22350630 DOI: 10.1007/s10995-012-0951-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The objective of this study is to inform medical home implementation in practices serving limited English proficiency Latino families by exploring limited English proficiency Latina mothers' experiences with, and expectations for, pediatric primary care. In partnership with a federally-qualified community health center in an urban Latino neighborhood, we conducted semi-structured interviews with 38 low-income Latina mothers. Eligible participants identified a pediatric primary care provider for their child and had at least one child 3 years old or younger, to increase the probability of frequent recent interactions with health care providers. Interview transcripts were coded and analyzed through an iterative and collaborative process to identify participants' satisfaction with and expectations for pediatric primary care. About half of the mothers interviewed were satisfied with their primary care experiences. Mothers suggested many ways to improve the quality of pediatric primary care for their children to better meet the needs of their families. These included: encouraging providers to invest more in their relationship with families, providing reliable same-day sick care, expanding hours, improving access to language services, and improving care coordination services. Limited English proficiency Latina mothers expect high-quality pediatric primary care consistent with the medical home model. Current efforts to improve primary care quality through application of the medical home model are thus relevant to this population, but should focus on the parent-provider relationship and timely access to care. Promoting this model among practices that serve limited English proficiency Latino families could improve engagement and satisfaction with primary care.
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Affiliation(s)
- Lisa Ross DeCamp
- Department of Pediatrics, Johns Hopkins University, Center for Child and Community Health Research, 5200 Eastern Ave, Baltimore, MD 21224, USA.
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Brown CM, Girio-Herrera EL, Sherman SN, Kahn RS, Copeland KA. Low-income parents' perceptions of pediatrician advice on early childhood education. J Community Health 2013; 38:195-204. [PMID: 23324946 PMCID: PMC3910351 DOI: 10.1007/s10900-012-9642-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The American Academy of Pediatrics recommends that pediatricians promote early childhood education (ECE). However, pediatricians have met resistance from low-income parents when providing anticipatory guidance on some topics outside the realm of physical health. Parents' views on discussing ECE with the pediatrician have not been studied. We sought to understand low-income parents' experiences and attitudes with regard to discussing ECE with the pediatrician and to identify opportunities for pediatrician input. We conducted 27 in-depth, semi-structured, qualitative interviews with parents of 3- and 4-year-old patients (100% Medicaid, 78% African American) at an urban primary care center. Interviews were audio-recorded, transcribed verbatim, and reviewed for themes by a multidisciplinary team. Most low-income parents in our study reported they primarily sought ECE advice from family and friends but were open to talking about ECE with the pediatrician. They considered their children's individual behavior and development to be important factors in ECE decisions and appreciated pediatricians' advice about developmental readiness for ECE. Participants' decisions about ECE were often driven by fears that their children would be abused or neglected. Many viewed 3 years as the age at which children had sufficient language skills to report mistreatment and could be safely enrolled in ECE. Participants were generally accepting of discussions about ECE during well child visits. There may be opportunity for the pediatrician to frame ECE discussions in the context of development, behavior, and safety and to promote high-quality ECE at an earlier age.
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Affiliation(s)
- Courtney M Brown
- Division of General and Community Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
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Zickafoose JS, DeCamp LR, Sambuco DJ, Prosser LA. Parents' preferences for enhanced access to the pediatric medical home: a qualitative study. J Ambul Care Manage 2013; 36:2-12. [PMID: 23222008 PMCID: PMC3728827 DOI: 10.1097/jac.0b013e318276dc2f] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Enhanced access services are key components of the patient-centered medical home, but they are resource-intensive and may require significant trade-offs by practices and patients. Using qualitative research methods, we interviewed 20 parents about experiences accessing primary care for their children, priorities for enhanced access, and willingness to make trade-offs. Parents had strong preferences for certain services, such as same-day sick care appointments, and were willing to make trade-offs for high-priority services. Primary care practices and medical home programs should educate families about trade-offs needed to implement new services and engage families in setting priorities for medical home implementation.
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Affiliation(s)
- Joseph S Zickafoose
- Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, USA.
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Abstract
INTRODUCTION Well child care is taught with individual visits in pediatric residency. Teaching residents how to deliver well child care efficiently is critical. Group well child care brings multiple families together for visits. The authors piloted group visits in pediatric residency clinic. METHODS The authors conducted group visits for 1- to 12-month old children. Seven families completed the group visits and were surveyed. Nine residents (intervention group) conducted group visits. Eighteen months after implementation, the intervention and control groups in the same clinic surveyed. RESULTS All families recommended group visits. The intervention group residents reported significantly more direct observations (P < .05). Trends toward improvement of teaching and role modeling for the intervention group were also observed. DISCUSSION The authors' continuity clinic had success implementing group visits, and families were recommended the visits. Group visits offer a natural environment to observe residents while exposing them to another way to deliver well child care.
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Affiliation(s)
- Michele Saysana
- Indiana University School of Medicine, Department of Pediatrics, Division of General and Community Pediatrics, Indianapolis, IN 46202, USA.
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Well-child care practice redesign for low-income children: the perspectives of health plans, medical groups, and state agencies. Acad Pediatr 2012; 12:43-52. [PMID: 22075467 PMCID: PMC4587656 DOI: 10.1016/j.acap.2011.08.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2011] [Revised: 08/02/2011] [Accepted: 08/09/2011] [Indexed: 01/17/2023]
Abstract
OBJECTIVE The aim of this study was to examine the views of key stakeholders in health care payer organizations on the use of practice redesign strategies to improve the delivery of well-child care (WCC) to low-income children aged 0 to 3 years. METHODS We conducted semistructured interviews with 18 key stakeholders (eg, chief medical officers, medical directors) in 11 California health plans and 2 medical group organizations serving low-income children, as well as the 2 state agencies that administer the 2 largest low-income insurance programs for California children. Discussions were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis. RESULTS Participants reported that nonphysicians were underutilized as WCC providers, and group visits and Internet services were likely a more effective way to provide anticipatory guidance and behavioral/developmental services. Participants described barriers to redesign, including the start-up costs required to implement redesign as well as a lack of financial incentives to support innovation in WCC delivery. Participants suggested solutions to these barriers, including using pay-for-performance programs to reward practices that expanded WCC services, and providing practices with start-up grants to implement pilot redesign projects that would eventually become self-sustaining. State-level barriers included poor Medicaid reimbursement rates and disincentives to innovation created by current Healthcare Effectiveness Data and Information Set measures. CONCLUSIONS All stakeholders will ultimately be needed to support WCC redesign; however, California payers may need to provide logistic, design, and financial support to practices, whereas state agencies may need to reshape the incentives to reward innovation around child preventive health and developmental services.
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Hambidge SJ, Phibbs S, Beck A, Bergman DA. Internet-based developmental screening: a digital divide between English- and Spanish-speaking parents. Pediatrics 2011; 128:e939-46. [PMID: 21911347 DOI: 10.1542/peds.2010-0111] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Internet-based developmental screening is being implemented in pediatric practices across the United States. Little is known about the application of this technology in poor urban populations. OBJECTIVE We describe here the results of focus groups, surveys, and in-depth interviews during home visits with families served by an urban safety-net organization to address the question of whether it is possible to use Internet or e-mail communication for medical previsit engagement in a population that is majority Hispanic, of low socioeconomic status, and has many non-English-speaking families. METHODS This study included families in 4 clinics within a safety-net health care system. The study design included the use of (1) parental surveys (n = 200) of a convenience sample of parents whose children received primary care in the clinics, (2) focus groups (n = 7 groups) with parents, and (3) in-depth interviews during home visits with 4 families. We used χ(2) and multivariate analyses to compare Internet access in English- and Spanish-speaking families. Standard qualitative methods were used to code focus-group texts and identify convergent themes. RESULTS In multivariate analysis, independent factors associated with computer use were English versus Spanish language (odds ratio: 3.2 [95% confidence interval: 1.4-6.9]) and education through at least high school (odds ratio: 4.7 [95% confidence interval: 2.3-9.7]). In focus groups, the concept of parental previsit work, such as developmental screening tests, was viewed favorably by all groups. However, many parents expressed reservations about doing this work by using the Internet or e-mail and stated a preference for either paper or telephone options. Many Spanish-speaking families discussed lack of access to computers and printers. CONCLUSIONS In this economically disadvantaged population, language and maternal education were associated with access to the Internet. Given the potential power of previsit work to tailor well-child visits to the needs of individual families, alternative strategies to using the Internet should be explored for populations without reliable Internet access.
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Affiliation(s)
- Simon J Hambidge
- Department of Community Health Services, Denver Health, Denver, Colorado 80204, USA.
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Predictors of well child care adherence over time in a cohort of urban Medicaid-eligible infants. BMC Pediatr 2011; 11:36. [PMID: 21575161 PMCID: PMC3118120 DOI: 10.1186/1471-2431-11-36] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Accepted: 05/15/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Changes in well child care (WCC) adherence over time have not previously been examined. Our objective is to describe adherence rates to WCC over time in a low-income urban population of infants 0-24 months of age, and to identify predictors of WCC adherence in this population. METHODS This is a secondary analysis of a cohort of Medicaid-eligible children followed from birth to 2 years between 2005 and 2008 with structured telephone surveys to assess maternal well-being, social support, and household and demographic information. For the 260 children attending 4 urban pediatric practices, WCC adherence was assessed based on visit data abstracted from electronic medical records. A random-intercept mixed effects logit model clustered on subject was used. RESULTS 92% of the mothers were African-American, 27% had not finished high school, 87% were single, and 43% earned<$500/month; mean age was 23. WCC adherence decreased from 88% at 6 months to 47% (12 mo), 44% (18 mo), and 67% (24 mo). The difference across time periods was statistically significant (p<0.001). Married (OR 1.71, p=0.02) and primiparous (OR 1.89, p<0.001) mothers had significantly greater odds of adherence, along with women who reported having been adherent to prenatal care visits (OR 1.49, p=0.03) and those with the lowest household income (OR 1.40, p=0.03). CONCLUSIONS Maternal education efforts should emphasize the importance of establishing WCC, especially for mothers of more than one child. Further studies using larger, more broadly defined populations are needed to confirm our findings that efforts to increase WCC adherence should be intensified after 6 months of age, particularly for children at higher risk.
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Coker TR, Sareen HG, Chung PJ, Kennedy DP, Weidmer BA, Schuster MA. Improving access to and utilization of adolescent preventive health care: the perspectives of adolescents and parents. J Adolesc Health 2010; 47:133-42. [PMID: 20638005 DOI: 10.1016/j.jadohealth.2010.01.005] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 01/05/2010] [Accepted: 01/07/2010] [Indexed: 10/19/2022]
Abstract
PURPOSE To examine the perspectives of publicly insured adolescents and their parents on ways to encourage adolescent utilization of preventive health services. METHODS We conducted eight focus groups with 77 adolescents enrolled in a large Medicaid managed care plan in Los Angeles County, California, and two focus groups with 21 of their parents. Discussions were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis. RESULTS Adolescents and parents reported that the most effective way to encourage preventive care utilization among teens was to directly address provider-level barriers related to the timeliness, privacy, confidentiality, comprehensiveness, and continuity of their preventive care. They reported that incentives (e.g., cash, movie tickets, gift cards) might also be an effective way to increase preventive care utilization. To improve adolescent receipt of surveillance and guidance on sensitive health-related topics, most adolescents suggested that the best way to encourage clinician-adolescent discussion was to increase private face-to-face discussions with a clinician with whom they had a continuous and confidential relationship. Adolescents reported that the use of text messaging, e-mail, and Internet for providing information and counseling on various sensitive health-related topics would also encourage adolescent utilization of preventive health services. Parents, however, more often preferred that their teen receive these services through in-office discussions and clinician-provided brochures. CONCLUSIONS State agencies, health plans, clinics, and individual providers may consider focusing their efforts to improve adolescents' utilization of preventive services on basic structural and quality of care issues related to the clinician-patient relationship, access to services, and confidentiality.
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Affiliation(s)
- Tumaini R Coker
- Department of Pediatrics, Mattel Children's Hospital, David Geffen School of Medicine at UCLA, Los Angeles, California 90024, USA.
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