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Jeung J. Group well child care and risk for developmental delay: Preliminary findings among Asian immigrants. Infant Behav Dev 2023; 73:101887. [PMID: 37757543 DOI: 10.1016/j.infbeh.2023.101887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/29/2021] [Accepted: 09/21/2023] [Indexed: 09/29/2023]
Abstract
Group well-child care (GWCC) may promote interactive caregiving and prevent developmental delay. METHOD This cross-sectional study explored the association between GWCC attendance and odds for suspected developmental delay among low-income Asian immigrants as measured by the Ages and Stages Questionnaire (ASQ)-III at age 18 months. RESULTS Odds for suspected developmental delay (OR=0.81, 95 % CI 0.40-1.62) were not significantly lower for GWCC infants. However, odds for developmental risk were significantly lower for GWCC infants in the ASQ's problem-solving domain (OR= 0.40, 95 % CI 0.17-0.92). CONCLUSION Among low-income Asian immigrants, GWCC participation may be associated with lower odds for cognitive developmental delay.
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Affiliation(s)
- Joan Jeung
- University of California San Francisco (UCSF), Department of Pediatrics, Division of Developmental Medicine, UCSF Box 3132, 675 18th Street, 2nd Floor, San Francisco, CA 94143, USA.
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Gresh A, Batchelder A, Glass N, Mambulasa J, Kapito E, MacDonald A, Ngutwa N, Plesko C, Chirwa E, Patil CL. Adapting group care to the postpartum period using a human-centered design approach in Malawi. BMC Health Serv Res 2023; 23:1098. [PMID: 37838673 PMCID: PMC10576327 DOI: 10.1186/s12913-023-10036-2] [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] [Received: 11/01/2022] [Accepted: 09/14/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND Responsive and resilient strategies to reduce high rates of maternal and infant mortality and clinician shortages are needed in low- and middle-income countries (LMICs). Malawi has some of the highest maternal and infant mortality rates globally. Group healthcare is a service delivery model that integrates these strategies. Although primarily implemented during the prenatal period, its potential for improving both maternal and infant health outcomes during the postpartum period has not been realized. The purpose of this study was to adapt and co-design the prototype for an evidence-based group care model for the postpartum period using a human-centered design approach with key stakeholders in Malawi. METHODS We completed steps of a framework guiding the use of human-centered design: 1) define the problem and assemble a team; 2) gather information through evidence and inspiration; 3) synthesize; and 4) intervention design: guiding principles and ideation. Qualitative methods were used to complete steps 2-4. In-depth interviews (n = 24), and incubator sessions (n = 6) that employed free listing, pile sorting and ranking were completed with key stakeholders. Data analysis consisted of content analysis of interviews and framework analysis for incubator sessions to produce the integrated group postpartum and well-child care model prototype. The fifth step is detailed in a separate paper. RESULTS All stakeholders reported a desire to participate in and offer group care in the postpartum period. Stakeholders worked collaboratively to co-create the prototype that included a curriculum of health promotion topics and interactive activities and the service delivery structure. Health promotion topic priorities were hygiene, breastfeeding, family planning, nutrition, and mental health. The recommended schedule included 6 sessions corresponding with the child vaccination schedule over the 12-month postpartum period. CONCLUSIONS Using a human-centered design approach to adapt an evidence-based group care model in an LMIC, specifically Malawi, is feasible and acceptable to key stakeholders and resulted in a prototype curriculum and practical strategies for clinic implementation.
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Affiliation(s)
- Ashley Gresh
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA.
| | - Anne Batchelder
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA
| | - Nancy Glass
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA
| | - Janet Mambulasa
- Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Esnath Kapito
- Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Amy MacDonald
- Pomelo Care, Hillsborough, North Carolina, USA
- Group Care Global, Philadelphia, PA, USA
| | - Nellie Ngutwa
- Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Cori Plesko
- Johns Hopkins University School of Nursing, 525 North Wolfe Street, Baltimore, MD, 21231, USA
| | - Ellen Chirwa
- Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Crystal L Patil
- School of Nursing, University of Michigan, 400 N. Ingalls, Suite 3320, Ann Arbor, MI, 48109, USA
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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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4
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Gresh A, Ahmed N, Boynton-Jarrett R, Sharifi M, Rosenthal MS, Fenick AM. Clinicians' Perspectives on Equitable Health Care Delivery in Group Well-Child Care. Acad Pediatr 2023; 23:1385-1393. [PMID: 37302699 DOI: 10.1016/j.acap.2023.06.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 05/14/2023] [Accepted: 06/03/2023] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore clinicians' perspectives about the impact of group well-child care (GWCC) on equitable health care delivery. METHODS In this qualitative study, we conducted semistructured interviews with clinicians engaged in GWCC recruited via purposive and snowball sampling. We first conducted a deductive content analysis using constructs from Donabedian's framework for health care quality (structure, process, and outcomes) followed by inductive thematic analysis within these constructs. RESULTS We completed 20 interviews with clinicians who deliver or research GWCC in 11 institutions across the United States. Four major themes around equitable health care delivery in GWCC emerged from clinicians' perspectives: 1) shifts in power dynamics (process); 2) enabling relational care, social support, and a sense of community (process, outcome); 3) centering multidisciplinary care delivery around patient and family needs (structure, process, and outcomes); and 4) unaddressed social and structural barriers limit patient and family participation. CONCLUSIONS Clinicians perceived that GWCC enhances equity in health care delivery by shifting hierarchies in clinical visits and promoting relational, patient, and family-centered care. However, potential opportunities exist to further address provider implicit bias in group care delivery and structural inequities at the level of the health care institution. Clinicians underscored the need to address barriers to participation so that GWCC can more fully enhance equitable health care delivery.
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Affiliation(s)
- Ashley Gresh
- Johns Hopkins University School of Nursing (A Gresh), Baltimore, Md
| | - Noureen Ahmed
- Department of Social and Behavioral Science, Yale School of Public Health (N Ahmed and M Sharifi), New Haven, Conn
| | - Renée Boynton-Jarrett
- Department of Pediatrics, Boston University School of Medicine (R Boynton-Jarrett), Mass
| | - Mona Sharifi
- Department of Pediatrics, Yale School of Medicine (M Sharifi, MS Rosenthal, and AM Fenick), New Haven, Conn; Department of Biostatistics, Yale School of Public Health (M Sharifi), New Haven, Conn
| | - Marjorie S Rosenthal
- Department of Pediatrics, Yale School of Medicine (M Sharifi, MS Rosenthal, and AM Fenick), New Haven, Conn
| | - Ada M Fenick
- Department of Pediatrics, Yale School of Medicine (M Sharifi, MS Rosenthal, and AM Fenick), New Haven, Conn.
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Okobi OE, Akahara PF, Nwachukwu OB, Egbuchua TO, Ajayi OO, Oranu KP, Ibanga IU. Analyzing Best Practices for Pediatric Well-Child Clinic Visits in the United States for Children Aged Three to Five Years: A Review. Cureus 2023; 15:e45194. [PMID: 37842432 PMCID: PMC10576162 DOI: 10.7759/cureus.45194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
Inadequate routine healthcare check-up visits for children aged three to five years impose substantial economic and social burdens due to morbidity and mortality. The absence of regular well-child visits and vaccinations leads to avoidable diseases, underscoring the need for a renewed emphasis on childhood immunizations and check-ups. Out of 160 articles initially screened after removing duplicates, 45 were chosen for full-text review following initial title and abstract screening by two independent reviewers. Afterward, 20 studies met the predefined inclusion criteria during the final assessment of full-text articles, and data were systematically extracted from these selected studies using standardized forms to ensure accuracy and consistency. Well-child visits promote holistic development, health, and well-being in children aged three to five years. Following established guidelines and evidence-based practices, healthcare professionals provide assessments, vaccinations, and guidance for a healthy future. Despite challenges, well-child visits are vital for preventive care, empowering informed decisions for children's growth and development. The benefits of well-child visits encompass growth monitoring, anticipatory guidance, and preventive measures, crucial for children with chronic illnesses. Key components include comprehensive assessments, developmental screenings, vision and hearing evaluations, immunizations, health education, and counseling. In the case of juvenile diabetes, parental education is paramount. Parents need to understand the intricacies of insulin administration, including proper dosage calculation based on glucose measurements, meal planning, and the importance of timing insulin injections. Implementing guidelines and principles by organizations such as Bright Futures and the American Academy of Pediatrics ensures holistic care, parent involvement, and evidence-based practices. This review explores best practices and guidelines for such visits, emphasizing their role in monitoring and promoting children's development.
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Affiliation(s)
- Okelue E Okobi
- Family Medicine, Larkin Community Hospital Palm Springs Campus, Miami, USA
- Family Medicine, Medficient Health Systems, Laurel, USA
- Family Medicine, Lakeside Medical Center, Belle Glade, USA
| | | | - Onyinyechukwu B Nwachukwu
- Neurosciences and Psychology, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Family Medicine, American International School of Medicine Georgetown, Guyana, USA
| | - Thelma O Egbuchua
- Pediatrics and Neonatology, Delta State University Teaching Hospital, Oghara, NGA
| | - Olamide O Ajayi
- Internal Medicine, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, NGA
| | - Kelechukwu P Oranu
- Obstetrics and Gynecology, Kenechukwu Specialist Hospital and Maternity Enugu, Enugu, NGA
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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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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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Milcent K, Gassama M, Dufourg MN, Thierry X, Charles MA, Bois C. Child health screening program in French nursery schools: Results and related socioeconomic factors. Front Pediatr 2023; 11:1167539. [PMID: 37215596 PMCID: PMC10192858 DOI: 10.3389/fped.2023.1167539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/03/2023] [Indexed: 05/24/2023] Open
Abstract
Objectives The study aims to describe the output of routine health screening performed in French nursery schools by the maternal and child health services among children aged 3-4 years and to quantify the level of early socioeconomic health disparities. Methods In 30 participating départements, data on screening for vision and hearing impairments, overweight and thinness, dental health, language, psychomotor development, and immunizations were collected for children born on specific dates in 2011 and enrolled in nursery school in 2014-2016. Information was collected on the children, their socioeconomic characteristics and on the school attended. Odds of abnormal screening results were compared for each socioeconomic factor by logistic regressions adjusted for age, sex, prematurity and bilingualism. Results Among the 9,939 children screened, prevalence of disorders was 12.3% for vision, 10.9% for hearing, 10.4% for overweight, 7.3% for untreated caries, 14.2% for language and 6.6% for psychomotricity. Newly detected visual disorders were more frequent in disadvantaged areas. Children with unemployed parents were three time more likely to have untreated caries and twice as likely to present language or psychomotor impairments; 52% were referred to a health professional following screening compared to 39% of children with employed parents. Except for children in disadvantaged areas, vaccine coverage was lower among disadvantaged groups. Conclusion The prevalences of impairments, which are higher among disadvantaged children, highlight the potential preventive impact of systematic screening under the comprehensive maternal and child healthcare program. These results are important to quantify early socioeconomic inequalities in a Western country known for its generous social welfare system. A more holistic approach to child health is needed with a coherent system involving families and aligning primary care, local child health professionals, general practitioners, and specialists. Further results are needed to evaluate its impact on later child development and health.
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Affiliation(s)
| | | | | | | | - Marie-Aline Charles
- ELFE Joint Unit INED-INSERM-EFS, Paris, France
- Centre for Researchin Epidemiology and Statistics (CRESS), INSERM, INRAE, Universite de Paris, Paris, France
| | - Corinne Bois
- Service Départemental de Protection Maternelle et Infantile, Conseil Départemental de l’Essonne, Evry, France
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Sotelo Guerra LJ, Ortiz J, Liljenquist K, Szilagyi PG, Fiscella K, Porras-Javier L, Johnson G, Friesema L, Coker TR. Implementation of a community health worker-focused team-based model of care: What modifications do clinics make? FRONTIERS IN HEALTH SERVICES 2023; 3:989157. [PMID: 36926506 PMCID: PMC10012691 DOI: 10.3389/frhs.2023.989157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 01/09/2023] [Indexed: 01/31/2023]
Abstract
Background Team-based care offers potential for integrating non-clinicians, such as community health workers (CHWs), into the primary care team to ensure that patients and families receive culturally relevant care to address their physical, social, and behavioral health and wellness needs. We describe how two federally qualified health center (FQHC) organizations adapted an evidence-based, team-based model of well-child care (WCC) designed to ensure that the parents of young children, aged 0-3, have their comprehensive preventive care needs met at WCC visits. Methods Each FQHC formed a Project Working Group composed of clinicians, staff, and parents to determine what adaptations to make in the process of implementation of PARENT (Parent-Focused Redesign for Encounters, Newborns to Toddlers), a team-based care intervention that uses a CHW in the role of a preventive care coach. We use the Framework for Reporting Adaptations and Modifications to Evidence-based interventions (FRAME) to chronicle the various intervention modifications and the adaptation process, focusing on when and how modifications occurred, whether it was planned or unplanned, and the reasons and goals for the modification. Results The Project Working Groups adapted several elements of the intervention in response to clinic priorities, workflow, staffing, space, and population need. Modifications were planned and proactive, and were made at the organization, clinic, and individual provider level. Modification decisions were made by the Project Working Group and operationalized by the Project Leadership Team. Examples of modifications include the following: (1) changing the parent coach educational requirement from a Master's degree to a bachelor's degree or equivalent experience to reflect the needs of the coach role; (2) the use of FQHC-specific templates for the coach's documentation of the pre-visit screening in the electronic health record; and (3) the use of electronic social needs referral tools to help the coach track and follow up on social need referrals. The modifications did not change the core elements (i.e., parent coach provision of preventive care services) or intervention goals. Conclusions For clinics implementing team-based care interventions, the engagement of key clinical stakeholders early and often in the intervention adaptation and implementation process, and planning for intervention modifications at both at an organizational level and at a clinical level are critical for local implementation.
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Affiliation(s)
- Laura J. Sotelo Guerra
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Janette Ortiz
- Department of Pediatrics, University of California, Los Angeles, CA, United States
| | - Kendra Liljenquist
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, United States
| | - Peter G. Szilagyi
- Department of Pediatrics, University of California, Los Angeles, CA, United States
| | - Kevin Fiscella
- Department of Family Medicine, University of Rochester, Rochester, NY, United States
| | - Lorena Porras-Javier
- Department of Pediatrics, University of California, Los Angeles, CA, United States
| | - Gina Johnson
- Northeast Valley Health Corporation, San Fernando, CA, United States
| | | | - Tumaini R. Coker
- Center for Child Health, Behavior, and Development, 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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McGowan A, Boundy EO, Nelson JM, Hamner HC. Patterns in Mothers' Recollection of Health Care Providers' Young Child Feeding Recommendations. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2022; 54:1024-1033. [PMID: 36357041 PMCID: PMC11036331 DOI: 10.1016/j.jneb.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/15/2022] [Accepted: 08/21/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Characterize feeding guidance mothers recall receiving from their child's health care provider (HCP). DESIGN Cross-sectional study of mothers participating in the 2017-2019 National Survey of Family Growth. PARTICIPANTS US mothers reporting (n = 1,302) information about their youngest child (aged 6 months to 5 years). VARIABLES MEASURED Weighted percentage of mothers who recalled their child's HCP discussing 6 different feeding topics by demographic characteristics. ANALYSIS Logistic regression assessing the relationship between recall of feeding guidance and demographics. RESULTS In this sample, 36.9% of mothers (95% confidence interval, 32.3-41.4) recalled HCPs recommending solid food before 6 months old (34.6% at 4-5 months, and 2.3% before 4 months). Mothers who were older or had a higher education level were more likely than their counterparts to recall their HCP discussing several of the feeding topics examined. CONCLUSION AND IMPLICATIONS Mothers reported high recollection of early childhood nutrition guidance from their HCP; however, certain topics (eg, appropriate timing of solid food introduction) could be prioritized, and some subpopulations may need additional focus to improve receipt of messages. A better understanding of variability in recall of feeding guidance could provide information for interventions to address barriers to receiving and retaining guidance.
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Affiliation(s)
- Andrea McGowan
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA; Oak Ridge Institute for Science and Education, Oak Ridge, TN
| | - Ellen O Boundy
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA; US Public Health Service, Rockville, MD
| | - Jennifer M Nelson
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA; US Public Health Service, Rockville, MD
| | - Heather C Hamner
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.
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11
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Perdomo J, Hernandez B, Munoz Ruiz J, Griffin M, Rea CJ. Impacting Caregiver Self-efficacy and Stress During the COVID-19 Pandemic Through a Virtual Toddler Group Visit Pilot. Clin Pediatr (Phila) 2022; 61:12-16. [PMID: 34565190 DOI: 10.1177/00099228211048597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Joanna Perdomo
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | | | | | - Melanie Griffin
- Boston Children's Hospital Early Intervention, Boston, MA, USA
| | - Corinna J Rea
- Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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12
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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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13
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Bunik M, Galloway K, Maughlin M, Hyman D. "First Five" Quality Improvement Program Increases Adherence and Continuity with Well-child Care. Pediatr Qual Saf 2021; 6:e484. [PMID: 34934873 PMCID: PMC8677984 DOI: 10.1097/pq9.0000000000000484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 06/26/2021] [Indexed: 11/26/2022] Open
Abstract
The American Academy of Pediatrics Bright Futures recommends routine well-child care as optimal care for children. This quality improvement project aimed to increase adherence to the "First Five" visits after newborn follow-up at 2, 4, 6, 9, and 12 months-by 25% (50% or higher) and continuity with providers by 20% (64% or higher) between 2013 and 2016. METHODS Retrospective data collection identified a quality gap, in which only 25% had the required well-child visits by the first year. We interviewed parents/caregivers of 12- to 15-month-old children for their perspectives on access to care, scheduling, and the medical home concept. Plan-Do-Study-Act cycles targeted modification of electronic medical record templates, scheduling, staff and parental education, standardization of work processes, and birth to 1-year age-specific incentives. We then piloted interventions in one of our clinic's pod/subgroup. Process and outcome measures were analyzed using descriptive statistics, a run chart, and a 2-sample % Defective Test. RESULTS Parent/caregiver interviews revealed that only 6% knew what a medical home was, and only 40% "almost always saw the same provider for care." At baseline in 2012, we documented completion of all 5 visits in only 25% of the children; <10% of those children had consecutive visits with the same provider. After multiple Plan-Do-Study-Act cycles and pilot, our "First Five" well-child care adherence rose to 78%, and continuity increased to 74% in 2018 (P < 0.001 for adherence, P < 0.001 for continuity). CONCLUSION A multifaceted, evidence-based approach improved both well-child care adherence and provider continuity.
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Affiliation(s)
- Maya Bunik
- From the Department of Pediatrics, University of Colorado Anschutz Medical Campus
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz Medical Campus
- Children’s Hospital Colorado
| | | | | | - Daniel Hyman
- Children’s Hospital of Philadelphia
- Department of Pediatrics and Leonard Davis Institute, University of Pennsylvania
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14
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Liljenquist K, Coker TR. Transforming Well-Child Care to Meet the Needs of Families at the Intersection of Racism and Poverty. Acad Pediatr 2021; 21:S102-S107. [PMID: 34740416 PMCID: PMC9439652 DOI: 10.1016/j.acap.2021.08.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 08/04/2021] [Accepted: 08/04/2021] [Indexed: 12/18/2022]
Abstract
Racism and poverty are intertwined throughout American society as a result of historic and current systemic oppression based on class and race. As the processes of pediatric preventive care, or well-child care, have evolved to better acknowledge and address health disparities due to racism and poverty, the structures of care have remained mostly stagnant. To cultivate long-term health and wellness of Black and Brown children, we must adopt an explicitly antiracist structure for well-child care. The pediatric medical home model is touted as the gold standard for addressing a host of health, developmental, and social needs for children and their families. However, the medical home model has not resulted in more equitable care for Black and Brown families living in poverty; there are ample data to demonstrate that these families often do not receive care that aligns with the principles of the medical home. This inequity may be most salient in the context of well-child care, as our preventive care services in pediatrics have the potential to impact population health. To appropriately address the vast array of preventive care needs of families living at the intersection of racism and poverty, a structural redesign of preventive care in the pediatric medical home is needed. In this paper, we propose a re-imagined framework for the structure of well-child care, with a focus on care for children in families living at the intersection of racism and poverty. This framework includes a team-based approach to care in which families build trusting primary care relationships with providers, as well as nonclinical members of a care team who have shared lived experiences with the community being served, and relies on primary care connections with community organizations that support the preventive health, social health, and emotional health needs of families of young children. Without a structural redesign of preventive care in the pediatric medical home, stand-alone revisions or expansions to processes of care cannot appropriately address the effects of racism and poverty on child preventive health outcomes.
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Affiliation(s)
- Kendra Liljenquist
- Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, Wash.
| | - Tumaini R Coker
- Department of Pediatrics, University of Washington, Seattle Children's Research Institute, Seattle, Wash
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15
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Irigoyen MM, Leib SM, Paoletti AM, DeLago CW. Timeliness of Immunizations in CenteringParenting. Acad Pediatr 2021; 21:948-954. [PMID: 33279737 DOI: 10.1016/j.acap.2020.11.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 11/13/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the timeliness of immunizations of children in CenteringParenting (Centering), a group well-child model, compared to children in individual well-child care. METHODS We conducted a retrospective cohort study of infants born October 1, 2014 to February 18, 2019 with a 2-month and subsequent well-child visit, both Centering or individual, at an academic pediatric practice in an urban, low-income community. In Centering, same age infants/mothers and a provider meet for 10, 2-hour group visits, and facilitated discussions. Providers are trained in group facilitation and participate in both Centering and individual visits. Primary outcome was timeliness of immunizations at 7, 13, 19, and 25 months. Analyses were by intention to treat. RESULTS The study population included 1735 children (Centering n = 342, individual n = 1393). By 25 months, 62% of children in Centering were up to date with all recommended immunizations compared to 44.2% of children in individual care, a 17.8% higher rate (P < .001). By 25 months, children in Centering made 3 additional well-child visits (9.2 vs 6.2, P < .001). Mediation analysis showed 82% of the effect on up to date status was due to increased attendance to well-child visits (P < .001); the remaining 18% was due to a Centering effect beyond the visit increase. CONCLUSIONS Our study showed a strong association of CenteringParenting with timeliness of immunizations and adherence to well-child visits compared to individual visits in a low income community. These findings warrant further exploration of the impact of Centering in reducing health disparities in communities at risk.
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Affiliation(s)
- Matilde M Irigoyen
- Department of Pediatric and Adolescent Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pa.
| | - Susan M Leib
- Department of Pediatric and Adolescent Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pa
| | - Andrew M Paoletti
- Department of Pediatric and Adolescent Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pa
| | - Cynthia W DeLago
- Department of Pediatric and Adolescent Medicine, Einstein Medical Center Philadelphia, Philadelphia, Pa
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16
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Friedman S, Calderon B, Gonzalez A, Suruki C, Blanchard A, Cahill E, Kester K, Muna M, Elbel E, Purushothaman P, Krause MC, Meyer D. Pediatric Practice Redesign with Group Well Child Care Visits: A Multi-Site Study. Matern Child Health J 2021; 25:1265-1273. [PMID: 33939054 DOI: 10.1007/s10995-021-03146-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Multiple barriers exist to delivering efficient, effective well child care, especially in low-income, immigrant communities. Practice redesign strategies, including group well child care, have shown promise in improving care delivery and healthcare outcomes. To assess the feasibility of a group well child care program at multiple urban, academic practices caring for underserved, mostly immigrant children, and to evaluate health outcomes and process measures compared to traditional care. METHODS Prospective, intervention control study with participants recruited to group well child care visits or traditional visits during the first year of life. A culturally sensitive curriculum was designed based on American Academy of Pediatrics (AAP) recommendations. Process and health outcomes were analyzed via patient surveys and medical record information. RESULTS One hundred and one families enrolled in group care and 74 in traditional care. Group care participants had higher rates of all recommended postpartum depression screening and domestic violence screening (65% vs 37%, 38% vs 17% respectively), higher anticipatory guidance retention (67% vs 37%) and higher patient satisfaction with their provider. The group care redesign did not increase length of time spent in clinic. CONCLUSIONS FOR PRACTICE Group well child care is a feasible method for practice redesign, which allows for increased psychosocial screening and anticipatory guidance delivery and retention compared to traditional visits, for low income, predominantly immigrant families. Parental satisfaction with group care is higher and these visits provide greater face-to-face time with the provider, without increasing time spent in the practice.
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Affiliation(s)
- Suzanne Friedman
- Department of Pediatrics, Columbia University Irving Medical Center, 622 W168th St. VC4-417, New York, NY, 10032, USA.
| | - Bianca Calderon
- Department of Pediatrics, Albert Einstein College of Medicine, New York, USA
| | - Amanda Gonzalez
- Department of Pediatrics, NewYork Presbyterian-Columbia University Pediatric Residency Program, New York, USA
| | - Caitlyn Suruki
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, USA
| | - Ashley Blanchard
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, USA
| | - Erin Cahill
- Department of Pediatrics, NewYork Presbyterian-Columbia University Pediatric Residency Program, New York, USA
| | - Kristen Kester
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, USA
| | - Martha Muna
- Department of Pediatrics, University of California San Francisco, Berkeley, USA
| | - Erin Elbel
- Department of Medicine, Boston Children's Hospital, Boston, USA
| | - Priya Purushothaman
- Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, USA
| | - M Christine Krause
- Department of Pediatrics, Columbia University Irving Medical Center, 622 W168th St. VC4-417, New York, NY, 10032, USA
| | - Dodi Meyer
- Department of Pediatrics, Columbia University Irving Medical Center, 622 W168th St. VC4-417, New York, NY, 10032, USA
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17
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Wasserman RC, Fiks AG. The Future(s) of Pediatric Primary Care. Acad Pediatr 2021; 21:414-424. [PMID: 33130066 DOI: 10.1016/j.acap.2020.10.015] [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: 06/22/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 10/23/2022]
Abstract
Pediatric primary care (PPC) arose in the early 20th century as the fusion of acute and chronic pediatric illness care with preventive elements borrowed from public and maternal and child health. Well-established and thriving by the 1930s, PPC saw major changes in childhood morbidity and mortality in the latter half of the 20th century with the recognition of the "new morbidity" of school, behavior, and social problems. At the same time, PPC experienced changes in its workforce, which became increasingly female and added nurse practitioners and physician assistants as practitioners. Independent practice, previously the dominant business model, decreased in prominence at the end of the 20th century as health systems bought practices and other sites morphed into federally qualified health centers. In the present century, electronic health records (EHRs) have brought profound changes in PPC workflows and practitioner experience. In addition, disruptive market competition such as retail clinics and corporate telemedicine providers coupled with changes in health insurance from fee-for-service to value-based payment further challenge the care model and economics of PPC. Finally, recognition of family social circumstances as major determinants of children's health presents another challenge to the status quo. As such, although one PPC future may resemble its present state, a more innovative future is likely to include clinics and practices more oriented toward and linked to communities and directed at the social determinants of health. In addition, the rise in physical, behavioral, and social problems in practice call for a growing focus on wellness, including sleep, nutrition, and activity, that promises to reorient the PPC future in productive new directions. The half-way technology of current EHR systems will ideally be spun into electronic hubs that facilitate teamwork between PPC, specialists, and community groups. Research and practice improvement strategies including involvement in "learning health systems" will be critical to making PPC effective in an evolving society. Although threatened by 21st century forces and hard-to-anticipate change, PPC is ideally positioned to build upon its core functions to create multidisciplinary teams that reach into the community, promoting a holistic wellness for children consistent with the broadest definition of health.
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Affiliation(s)
- Richard C Wasserman
- Larner College of Medicine, University of Vermont (RC Wasserman), Charlotte, Vt.
| | - Alexander G Fiks
- Children's Hospital of Philadelphia, Department of Pediatrics, Center for Pediatric Clinical Effectiveness, and the Possibilities Project, Roberts Center for Pediatric Research (AG Fiks), Philadelphia, Pa
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18
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Oldfield BJ, Rosenthal MS, Coker TR. Update on the Feasibility, Acceptability, and Impact of Group Well-Child Care. Acad Pediatr 2020; 20:731-732. [PMID: 32120016 DOI: 10.1016/j.acap.2020.02.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 02/14/2020] [Accepted: 02/24/2020] [Indexed: 12/17/2022]
Affiliation(s)
- Benjamin J Oldfield
- Fair Haven Community Health Care (BJ Oldfield, MS Rosenthal), New Haven, Conn; Department of Pediatrics, Yale School of Medicine (MS Rosenthal), New Haven, Conn.
| | - Marjorie S Rosenthal
- Department of Pediatrics, Yale School of Medicine (MS Rosenthal), New Haven, Conn
| | - Tumaini R Coker
- University of Washington School of Medicine (TR Coker), Seattle, Wash; Seattle Children's Research Institute (TR Coker), Seattle, Wash
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19
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Abstract
Age-specific recommendations contain extensive information that cannot be presented adequately in pediatric preventative care visits. Parental guidance is important, especially for children with social and/or medical risks, but existing evidence-based interventions tend to be resource intensive and difficult to scale. Because the use of mobile technology is now prevalent even among low-income families, the benefits of utilizing the Internet and mobile apps to improve parental guidance are active areas of research. Analyses of patient-generated data from mobile apps may help identify effective ways to use social influences, social learning, and social networks for improving population health.
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Affiliation(s)
- Barry Zuckerman
- Department of Pediatrics, Boston Medical Center, 801 Harrison Avenue, Boston, MA 02118, USA.
| | - Chun Y Ng
- New School for Leadership in Healthcare, Koo Foundation Sun Yat-Sen Cancer, No. 125 Lide Road, Beitou District, Taipei, Taiwan
| | | | - C Jason Wang
- Department of Pediatrics, Center for Policy, Outcomes, and Prevention, Stanford University School of Medicine, 117 Encina Commons, Stanford, CA 94305, USA
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20
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Jee SH, Conn AM, Conrow M, Alpert-Gillis L, Herendeen N. Just Stand There and Listen. Clin Pediatr (Phila) 2020; 59:749-751. [PMID: 32338041 DOI: 10.1177/0009922820915890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sandra H Jee
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Megan Conrow
- University of Rochester Medical Center, Rochester, NY, USA
| | | | - Neil Herendeen
- University of Rochester Medical Center, Rochester, NY, USA
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21
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Desai S, Chen F, Boynton-Jarrett R. Clinician Satisfaction and Self-Efficacy With CenteringParenting Group Well-Child Care Model: A Pilot Study. J Prim Care Community Health 2020; 10:2150132719876739. [PMID: 31550973 PMCID: PMC6764027 DOI: 10.1177/2150132719876739] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Group-based models for well-child care have been shown
to positively affect patient experience. One promising group well-child care
model is CenteringParenting. However, clinician self-efficacy with delivery of
the model is unknown and clinician satisfaction with the model has been
understudied. Objectives: To investigate sense of self-efficacy,
degree of satisfaction, and comfort with trauma-informed care (TIC) among
diverse clinical providers implementing the CenteringParenting curriculum. We
also examined the relationship between self-efficacy, satisfaction, and comfort
with TIC, and delivery of the model. Methods: Electronic surveys
were sent to CenteringParenting providers (N = 98) from 49 clinics. Providers (N
= 41) from 24 clinical sites completed the survey, corresponding to a 42%
individual and 49% site response rate. Surveys explored provider: satisfaction
with the curriculum, perceived self-efficacy, and perspective on competency with
TIC. Results: Providers indicated that the CenteringParenting model
achieves each of its four objectives (means ranged from 4.10 to 4.52 for each
objective, with 5 being the highest possible response). Providers rated their
level of satisfaction (scale of 1 [unsatisfied] to 5 [very satisfied]) with
their ability to address patient concerns higher with CenteringParenting in the
group care setting (mean = 4.10) than in the individual care setting (mean =
3.55). Respondents demonstrated a high mean average Self-Efficacy in Group Care
score of 93.63 (out of 110). Unadjusted logistical regression analyses
demonstrated that higher provider Self-Efficacy in Group Care score (odds ratio
[OR] = 1.08) and higher comfort with TIC (OR = 22.16) is associated with
curriculum content being discussed with a facilitative approach.
Conclusions: Providers from diverse clinical sites report high
satisfaction with and self-efficacy in implementing the CenteringParenting
model.
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Affiliation(s)
- Shyam Desai
- Boston University School of Medicine, Boston, MA, USA.,University of Connecticut School of Medicine, Farmington, CT, USA
| | - Futu Chen
- Boston University School of Medicine, Boston, MA, USA.,Harvard TH Chan School of Public Health, Boston, MA, USA
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22
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Novick G, Womack JA, Sadler LS. Beyond Implementation: Sustaining Group Prenatal Care and Group Well-Child Care. J Midwifery Womens Health 2020; 65:512-519. [PMID: 32519425 DOI: 10.1111/jmwh.13114] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 03/01/2020] [Accepted: 03/09/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Group prenatal care and group well-child care (collectively called group care) provide health care in groups. Group care is being introduced in many settings, and the model's benefits are increasingly recognized. Yet, little attention has been paid to understanding model sustainability. This study examined barriers to sustainability and offers suggestions for sustaining group care programs. METHODS This qualitative research was guided by interpretive description. Semistructured interviews with 17 professionals were conducted in 4 sites in one community to explore barriers to sustaining group care and key ingredients for sustainability. Sites were 2 clinics that had provided group prenatal care, a clinic currently providing group prenatal care, and a clinic currently providing group well-child care. Two clinics have continued providing group care and 2 have discontinued it. Participants included midwives, physicians, nurses, and nurse practitioners. Interviews were audio recorded, transcribed, and entered in ATLAS.ti. A priori and inductive coding schemes were developed; code content was compared across individuals, participant types, and settings. RESULTS Five themes were identified: administrative buy-in, robust recruitment, clinician and staff buy-in, owning it, and sustainability mindset. Group care needs to be sold to many different constituencies: administrators, staff and clinicians, and patients. Furthermore, sustainability requires having a conscious awareness of the importance of sustainability from the outset, taking ownership by adapting group care to needs of settings, creating venues for expressing divergent viewpoints and problem-solving, and recognizing that these processes are ongoing with change occurring incrementally. It also includes addressing the need for long-term financing. DISCUSSION Those implementing group care must be prepared to go beyond managing the logistics of introducing a complex new program; they must also be prepared to develop sustainability mindsets, sell the model to everyone on all levels within their institutions, and advocate for enhanced reimbursement for group care and value-driven payment systems.
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Affiliation(s)
- Gina Novick
- Yale University School of Nursing, West Haven, Connecticut
| | - Julie A Womack
- Yale University School of Nursing, West Haven, Connecticut.,VA Connecticut Healthcare System, West Haven, Connecticut
| | - Lois S Sadler
- Yale University School of Nursing, West Haven, Connecticut.,Yale Child Study Center, New Haven, Connecticut
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Characteristics of High-Performing Primary Care Pediatric Practices: A Qualitative Study. Acad Pediatr 2020; 20:267-274. [PMID: 31004815 PMCID: PMC6800598 DOI: 10.1016/j.acap.2019.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2018] [Revised: 03/31/2019] [Accepted: 04/09/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Performance on pediatric quality measures varies across primary care practices. Health care quality is associated with organizational factors, but their effect is understudied in pediatric care. This study aimed to develop hypotheses regarding the relationship between organizational factors and composite scores on pediatric quality measures. METHODS Using a positive deviance approach, semistructured interviews were conducted with pediatricians and staff (N = 35) at 10 purposively selected high-performing pediatric primary care practices in Massachusetts between September and December 2016. Practices were sampled to achieve diversity in geographic location, size, and organizational structure. Interviews aimed to identify organizational strategies (eg, care processes) and contextual factors (eg, teamwork) that may be associated with performance on quality measures. Interviews were audiotaped, transcribed, and analyzed using qualitative content analytic methods. RESULTS We identified 4 major themes (MTs): MT1, Practice Culture; MT2, Practice Structures and Quality Improvement Tools; MT3, Attitudes and Beliefs Related to Measuring Care Quality; and MT4, Perceived Barriers to Achieving High Performance on Quality Measures. MT1 subthemes included contextual factors such as teamwork, leadership, and feeling respected as an employee. MT2 subthemes included fixed characteristics such as practice size and strategies such as the use of an electronic medical record. MT3 and MT4 subthemes linked these constructs to factors external to the practices. CONCLUSIONS This study suggested that elements of organizational culture may play as important a role in the quality of care delivered as specific quality improvement strategies. Interventions to further test this relationship may aid practices seeking to improve the care they deliver.
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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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Organizational characteristics associated with high performance on quality measures in pediatric primary care: A positive deviance study. Health Care Manage Rev 2019; 46:196-205. [PMID: 31116122 PMCID: PMC6864254 DOI: 10.1097/hmr.0000000000000247] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric health care quality in the United States varies, but the reasons for variation are not fully understood. Differences in pediatric practices' organizational characteristics, such as organizational structures, strategies employed to improve quality, and other contextual factors, may contribute to the variation observed. PURPOSE To assess the relationship between organizational characteristics and performance on clinical quality (CQ) and patient experience (PE) measures in primary care pediatric practices in Massachusetts. METHODOLOGY A 60-item questionnaire that assessed the presence of selected organizational characteristics was sent to 172 pediatric practice managers in Massachusetts between December 2017 and February 2018. The associations between select organizational characteristics and publicly available CQ and PE scores were analyzed using analysis of variance; open-ended survey questions were analyzed using qualitative content analysis. RESULTS Eighty-six practices (50.0%) responded; 80 (46.5%) were included in the primary analysis. Having a quality champion ( p = .03), offering co-located specialty services (e.g., behavioral health; p = .04), being a privately owned practice ( p = .04), believing that patients and families feel respected ( p = .03), and having a lower percentage of patients (10%-25%) covered by public health insurance ( p = .04) were associated with higher CQ scores. Higher PE scores were associated with private practice ownership ( p = .0006). Qualitative analysis suggested organizational culture and external factors, such as health care finance, may affect quality. CONCLUSIONS Both modifiable organizational practices and factors external to a practice may affect quality of care. Addressing differences in practice performance may not be reducible to implementation of changes in single organizational characteristics. PRACTICE IMPLICATIONS Pediatric practices seeking to improve quality of care may wish to adopt the strategies that were associated with higher performance on quality measures, but additional studies are needed to better understand the mechanisms behind these associations and how they relate to each other.
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Allport BS, Solomon BS, Johnson SB. The Other Parent: An Exploratory Survey of Providers' Engagement of Fathers in Pediatric Primary Care. Clin Pediatr (Phila) 2019; 58:555-563. [PMID: 30762423 DOI: 10.1177/0009922819829032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although father engagement in pediatric care is associated with positive child health outcomes, pediatric primary care providers (PCPs) often focus on the mother-child dyad. This study sought to characterize pediatric PCPs' engagement of fathers in care. Pediatric PCPs affiliated with an academic health system were invited to complete an online survey. The primary outcome was the proportion of providers who routinely implement American Academy of Pediatrics recommendations for father engagement. There were 100 respondents. Of the 23 recommended practices for engaging fathers, 18 were routinely implemented by <50% of respondents. The least routinely implemented practices were parenting skills support (4%) and perinatal depression screening (5%). The most commonly endorsed barriers included lack of father attendance at visits (91%) and time constraints (75%). Despite the American Academy of Pediatrics recommendations, pediatric PCPs do not routinely engage fathers in care. Effective strategies are needed to reduce barriers and improve father engagement among pediatric providers.
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Platt RE, Spencer AE, Burkey MD, Vidal C, Polk S, Bettencourt AF, Jain S, Stratton J, Wissow LS. What's known about implementing co-located paediatric integrated care: a scoping review. Int Rev Psychiatry 2018; 30:242-271. [PMID: 30912463 PMCID: PMC6499629 DOI: 10.1080/09540261.2018.1563530] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Several studies have demonstrated clinical benefits of integrated care for a range of child and adolescent mental health outcomes. However, there is a significant gap between the evidence for efficacy of integrated care interventions vs their implementation in practice. While several studies have examined large-scale implementation of co-located integrated care for adults, much less is known for children. The goal of this scoping review was to understand how co-located mental health interventions targeting children and adolescents have been implemented and sustained. The literature was systematically searched for interventions targeting child and adolescent mental health that involved a mental health specialist co-located in a primary care setting. Studies reporting on the following implementation outcomes were included: acceptability, adoption, appropriateness, feasibility, fidelity, implementation cost, penetration, and sustainability. This search identified 34 unique studies, including randomized controlled trials, observational studies, and survey/mixed method approaches. Components facilitating implementation of on-site integrated behavioural healthcare included interprofessional communication and collaboration at all stages of implementation; clear protocols to facilitate intervention delivery; and co-employment of integrated care providers by specialty clinics. Some studies found differences in service use by demographic factors, and others reported funding challenges affecting sustainability, warranting further study.
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Affiliation(s)
| | | | | | - Carolina Vidal
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Sarah Polk
- Department of Pediatrics, Johns Hopkins University School of Medicine
| | - Amie F Bettencourt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
| | - Sonal Jain
- New York Institute of Technology College of Osteopathic Medicine
| | - Julia Stratton
- Vancouver Coastal Health Authority, Pacific Spirit and Raven Song Child and Youth Mental Health Teams
| | - Lawrence S Wissow
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine
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Pluye P, Loignon C, Lagarde F, Doray G, El Sherif R, Granikov V, Gonzalez Reyes A, Bujold M, Grad R, Bartlett G, Barwick M, Schuster T, Turcotte E, Bouthillier F. Assessing and Improving the Use of Online Information About Child Development, Education, Health, and Well-Being in Low-Education, Low-Income Parents: Protocol for a Mixed-Methods Multiphase Study. JMIR Res Protoc 2018; 7:e186. [PMID: 30459143 PMCID: PMC6280034 DOI: 10.2196/resprot.9996] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/24/2018] [Accepted: 08/14/2018] [Indexed: 11/16/2022] Open
Abstract
Background This study is born from a partnership between Web editors of Naître et grandir (N&G) and AboutKidsHealth (AKH) and researchers who developed and validated the Information Assessment Method (IAM). N&G and AKH are popular Canadian websites with high-quality comprehensive information about child development, education, health, and well-being. IAM allows parents to assess online information and provide feedback to Web editors. High-quality online consumer health information improves knowledge, self-efficacy, and health. However, low-socioeconomic status (SES) parents underuse N&G and IAM, despite these parents being more likely to report decreased worries and increased confidence as outcomes from N&G information. Objective The study is aimed to improve low-SES parents’ use of online child information and interaction with Web editors and explore subsequent health outcomes for parents and children. Methods Multiphase mixed-methods design. Our general approach is centered on organizational participatory research. In phase 1, we will conduct a qualitative interpretive study to identify barriers and facilitators to using N&G information and to interacting with N&G editors via IAM; interview more than 10 low-SES parents about their experience with N&G and IAM and more than 10 nonusers of N&G and IAM; and use thematic analysis to identify main barriers and facilitators. In phase 2, we will integrate parents’ views (phase 1 findings) in N&G and IAM and implement a new version: IAM+N&G+. In phase 3, we will conduct a quantitative prospective longitudinal study (pre-/postimplementation monitoring of knowledge use and outcomes). We will compare the use of original (IAM and N&G) and new (IAM+ and N&G+) versions using Google Analytics variables, IAM variables, a material and social deprivation index, and demographics. We anticipate increased use post implementation (linear mixed modeling). In phase 4, we will conduct a qualitative descriptive study on outcomes of information use. We will interview more than 30 low-SES parents who receive and rate the N&G+ newsletter using IAM+ and analyze data in the form of life histories to describe how parents and children experience perceived outcomes. Results The project was funded in 2017 by the Canadian Institutes of Health Research and received an ethics approval by the McGill University’s institutional review board. Data collection for phase 1 was completed in 2018. Phases 2 to 4 will be conducted until 2020. Findings from this study will also be used to develop a free toolkit, useful to all Web editors, with recommendations for improving health information for low-SES persons and interactions with them using IAM. Conclusions The results of this study will provide a deep understanding of how low-SES parents use online child information and interact with Web editors. Following the implementation of IAM+N&G+, results will also elucidate subsequent health outcomes for low-SES parents and children after interaction with Web editors has been optimized. International Registered Report Identifier (IRRID) PRR1-10.2196/9996
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Affiliation(s)
- Pierre Pluye
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Christine Loignon
- Département de médecine de famille, Université de Sherbrooke, Longueuil, QC, Canada
| | | | - Geneviève Doray
- Naître et grandir, Fondation Lucie et André Chagnon, Montréal, QC, Canada
| | - Reem El Sherif
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Vera Granikov
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | | | - Mathieu Bujold
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Roland Grad
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Gillian Bartlett
- Department of Family Medicine, McGill University, Montréal, QC, Canada
| | - Melanie Barwick
- The Hospital for Sick Children, Research Institute, Toronto, ON, Canada
| | - Tibor Schuster
- Department of Family Medicine, McGill University, Montréal, QC, Canada
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Hackley B, Elyachar-Stahl E, Savage AK, Stange M, Hoffman A, Kavanaugh M, Aviles MM, Arévalo S, Machuca H, Shapiro A. A Qualitative Study of Women's Recall of Content and Skills Developed in Group Prenatal and Well-Baby Care 2 Years Later. J Midwifery Womens Health 2018; 64:209-216. [PMID: 30407720 DOI: 10.1111/jmwh.12899] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 05/25/2018] [Accepted: 06/01/2018] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Group prenatal and well-baby care is a system of health care visits that occur in a group setting. Each individual session lasts approximately 2 hours, allowing more time for education and support than can occur in an individual visit. Compared with individual care, research suggests that group care is associated with similar or better short-term outcomes, but no studies have yet examined potential long-term benefits beyond one year postpartum. The purpose of this qualitative descriptive study was to elicit women's recall about content covered in group prenatal and well-baby care and whether they were or were not continuing to use skills discussed during group prenatal and well-baby care 2 or more years after their group ended. METHODS Eligible women participated in group prenatal and/or well-baby care between 2008 and 2012, were aged at least 18 years, and were English-speaking. Of the 127 eligible women, 32 were reached and 17 agreed to participate. Women were interviewed on average 3 years after group prenatal or well-baby care ended using a semistructured interview guide. Transcripts were reviewed and coded by each team member. Final codes and themes were identified using an iterative review process among the research team. RESULTS Three themes were identified: sustained change, transferable skills, and group as a safe haven. All women were still using strategies discussed during group and had made sustained improvements in nutrition, stress management, and/or in the quality of their interactions with their children, partner, or families. The group environment was described as a safe haven: a respectful, nonjudgmental space that allowed women to share and support each other while learning new skills. DISCUSSION This is the first study to document that group prenatal and well-baby care is associated with long-term benefits in areas not yet reported in the literature: nutrition, family communication, and parenting.
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Pecker LH, Kappa S, Greenfest A, Darbari DS, Nickel RS. Targeted Hydroxyurea Education after an Emergency Department Visit Increases Hydroxyurea Use in Children with Sickle Cell Anemia. J Pediatr 2018; 201:221-228.e16. [PMID: 30251637 PMCID: PMC6159227 DOI: 10.1016/j.jpeds.2018.05.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 04/17/2018] [Accepted: 05/11/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate the impact of an initiative to increase hydroxyurea use among children with sickle cell anemia (SCA) who presented to the emergency department (ED). STUDY DESIGN This observational cohort study included children with SCA not taking hydroxyurea who presented to the ED with pain or acute chest syndrome and then attended a Quick-Start Hydroxyurea Initiation Project (Q-SHIP) session. A Q-SHIP session includes a hematologist-led discussion on hydroxyurea, a video of patients talking about hydroxyurea, and a direct offer to start hydroxyurea. RESULTS Over 64 weeks, 112 eligible patients presented to the ED and 59% (n = 66) participated in a Q-SHIP session a median of 6 days (IQR 2, 20 days) after ED or hospital discharge; 55% of participants (n = 36) started hydroxyurea. After a median follow-up of 49 weeks, 83% (n = 30) of these participants continued hydroxyurea. Laboratory markers of hydroxyurea adherence were significantly increased from baseline: median mean corpuscular volume +8.6 fL (IQR 5.0, 17.7, P < .0001) and median hemoglobin F +5.7% (IQR 2.5, 9.8, P = .0001). Comparing Q-SHIP participants to nonparticipants, 12 weeks after ED visit, participants were more likely to have started hydroxyurea than nonparticipants (53% vs 20%, P = .0004) and to be taking hydroxyurea at last follow-up (50% vs 20%, P = .001). Two years after the implementation of Q-SHIP the overall proportion of eligible patients on hydroxyurea presenting to our ED increased from 56% to 80%, P = .0069. CONCLUSIONS Participation in a clinic to specifically address starting hydroxyurea after a SCA complication increases hydroxyurea use.
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Affiliation(s)
- Lydia H. Pecker
- Division of Hematology, Department of Pediatrics, Johns Hopkins University, Baltimore MD
| | - Sarah Kappa
- Division of Hematology, Children’s National Health System, Washington D.C
| | - Adam Greenfest
- George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Deepika S. Darbari
- Division of Hematology, Children’s National Health System, Washington D.C,George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Robert Sheppard Nickel
- Division of Hematology, Children's National Health System, Washington, DC; George Washington University School of Medicine and Health Sciences, Washington, DC.
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Applying causal diagrams in pediatrics to improve research, communication, and practice. Pediatr Res 2018; 84:485-486. [PMID: 30018288 DOI: 10.1038/s41390-018-0109-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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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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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Qualitative Evaluation of Individual and Group Well-Child Care. Acad Pediatr 2018; 18:516-524. [PMID: 29355778 DOI: 10.1016/j.acap.2018.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 01/02/2018] [Accepted: 01/06/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Individual well care (IWC) is the standard delivery model for well-child care in the United States. Alternative models, such as group well care (GWC), may create opportunities to enhance care for babies. The purpose of this study was to evaluate parents' perceptions of social/wellness benefits and system challenges of IWC and GWC. METHODS Since 2014, we have provided both IWC and GWC at an urban academic practice serving a low-income minority community. We conducted a mixed method study involving surveys and 18 focus groups (11 IWC groups, n = 32 parents; 7 GWC groups, n = 33 parents). Parents completed surveys before convening focus group discussions. Survey results were analyzed using independent t tests; focus groups were digitally recorded, transcribed, and analyzed to identify themes. RESULTS Both groups had similar demographics: parents were mostly female (91%) and black (>80%); about half had incomes < $20,000. Parents' mean age was 27 years; children's mean age was 11 months. There were no significant differences in overall scores measuring trust in physicians, parent empowerment, or stress. IWC parents' themes highlighted ways to improve care delivery, while GWC parents highlighted both satisfaction with care delivery and social/wellness benefits. GWC parents strongly endorsed this model and reported unique benefits, such as garnering social support and learning from other parents. CONCLUSIONS Parents receiving both models of care identified ways to improve primary care delivery. Given some of the benefits reported by GWC parents, this model may provide the means to enhance resilience in parents and children in low-income communities.
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Garg P, Ha MT, Eastwood J, Harvey S, Woolfenden S, Murphy E, Dissanayake C, Williams K, Jalaludin B, McKenzie A, Einfeld S, Silove N, Short K, Eapen V. Health professional perceptions regarding screening tools for developmental surveillance for children in a multicultural part of Sydney, Australia. BMC FAMILY PRACTICE 2018; 19:42. [PMID: 29609547 PMCID: PMC5879732 DOI: 10.1186/s12875-018-0728-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/23/2016] [Accepted: 03/19/2018] [Indexed: 11/13/2022]
Abstract
Background Encouraging early child development and the early identification of developmental difficulties is a priority. The Ministry of Health in the Australian State of New South Wales (NSW), has recommended a program of developmental surveillance using validated screening questionnaires, namely, the Parents’ Evaluation of Development Status (PEDS) and Ages and Stages Questionnaire (ASQs), however, the use of these tools has remained sub-optimal. A longitudinal prospective birth cohort “Watch Me grow” study was carried out in the South Western Sydney (SW) region of NSW to ascertain the uptake as well as the strategies and the resources required to maximise engagement in the surveillance program. This paper reports on a qualitative component of the study examining the attitudes, enablers and barriers to the current developmental surveillance practices, with reference to screening tools, amongst health professionals. Methods Qualitative data from 37 primary health care providers in a region of relative disadvantage in Sydney was analysed. Results The major themes that emerged from the data were the “difficulties/problems” and “positives/benefits” of surveillance in general, and “specificity” of the tools which were employed. Barriers of time, tool awareness, knowledge and access of referral pathways, and services were important for the physician providers, while the choice of screening tools and access to these tools in other languages were raised as important issues by Child and Family Health Nurses (CFHN). The use of these tools by health professionals was also influenced by what the professionals perceived as the parents’ understanding of their child’s development. While the PEDS and ASQs was utilised by CFHNs, both General Practitioners (GPs) and paediatricians commented that they lacked awareness of developmental screening tools and highlighted further training needs. Conclusions The results highlight the practical challenges to, and limited knowledge and uptake of, the use of recommended screening tools as part of developmental surveillance. There is a need for further research regarding the most effective integrated models of care which will allow for a better collaboration between parents and service providers and improve information sharing between different professionals such as CFHNs GPs, Practices nurses and Paediatricians involved in screening and surveillance programs.
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Affiliation(s)
- Pankaj Garg
- Department of Community Paediatrics, Liverpool Hospital, Liverpool, NSW, Australia.,School of Women's and Children's Health, UNSW, Sydney, Australia.,School of Medicine, University of Sydney, Sydney, Australia.,Specialist Disability Health Team, Fairfield, Australia.,Ingham Institute of Applied Medicine, Liverpool, Australia
| | - My Trinh Ha
- ICAMHS, South Western Sydney Local Health District, Sydney, NSW, Australia.,University of Western Sydney, Sydney, Australia
| | - John Eastwood
- School of Women's and Children's Health, UNSW, Sydney, Australia.,School of Public Health, University of Sydney, Sydney, NSW, Australia.,Ingham Institute of Applied Medicine, Liverpool, NSW, Australia.,School of Medicine, Griffith University, Gold Coast, QLD, Australia.,Department of Community Paediatrics, Sydney Local Health District, Croydon Community Health Centre, Croydon, Sydney, Australia
| | - Susan Harvey
- School of Nursing and Midwifery, Griffiths University, Brisbane, QLD, Australia
| | - Sue Woolfenden
- Sydney Children's Hospital Network (Randwick), Randwick, Australia.,UNSW, Sydney, Australia
| | | | - Cheryl Dissanayake
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, VIC, Australia
| | - Katrina Williams
- Royal Children's Hospital, Melbourne, VIC, Australia.,University of Melbourne, Melbourne, Australia.,Murdoch Childrens Research Institute, Melbourne, Australia
| | - Bin Jalaludin
- NSW Ministry of Health, Sydney, Australia.,South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Anne McKenzie
- Child and Family Health Nursing, Primary and Community Health, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Stewart Einfeld
- Centre for Disability Research and Policy and Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Natalie Silove
- The Children's Hospital at Westmead, Westmead, NSW, Australia.,University of Sydney, Sydney, Australia
| | - Kate Short
- University of Sydney, Sydney, Australia.,Liverpool Hospital, South Western Sydney LHD, Liverpool, NSW, Australia
| | - Valsamma Eapen
- School of Medicine, Griffith University, Gold Coast, QLD, Australia. .,UNSW, ICAMHS, South Western Sydney LHD, Sydney, NSW, Australia. .,Chair, Infant Child and Adolescent Psychiatry, University of New South Wales, Head, Academic Unit of Child Psychiatry, South West Sydney (AUCS), ICAMHS, Mental Health Centre, L1, Liverpool Hospital, Elizabeth Street, Liverpool, Sydney, NSW, 2170, Australia.
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Uwemedimo OT, May H. Disparities in Utilization of Social Determinants of Health Referrals Among Children in Immigrant Families. Front Pediatr 2018; 6:207. [PMID: 30087887 PMCID: PMC6066553 DOI: 10.3389/fped.2018.00207] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 07/04/2018] [Indexed: 11/17/2022] Open
Abstract
Objective: Children in immigrant families (CIF) are at elevated risk of experiencing adverse social determinants of health (SDH), particularly material hardship, which contribute to disparate health outcomes. Previous studies have found that SDH screening programs integrated into pediatric practices have increased receipt of social service resources. Few studies have examined use of social services in these programs among ethnically-diverse patient populations and associations with caregiver immigrant status or limited English proficiency (LEP). Methods: Caregivers of children (<18 years) were routinely screened in a practice-based, SDH screening program offering referral, assisted navigation and follow-up support. Information on caregiver race/ethnicity, US nativity, citizenship status and self-reported English proficiency was collected. Associations with utilization of referral resources at 12 weeks were measured using Chi-square and Fisher's Exact tests. Results: Of 148 caregivers, most were mothers (83.2%) and non-White (91.9%). Over half were born outside of the U.S (59.7%) and one-third were LEP (33.6%). Approximately one-third (30.9%) successfully utilized program-provided resources at 12-week follow-up. LEP caregivers and undocumented caregivers were more likely to be lost-to-follow-up. However, LEP caregivers who remained in the program utilized resources more than English-proficient caregivers (38.4 vs. 18.4%, p = 0.031). Similarly, significantly more non-citizen caregivers utilized referrals compared to US citizens (37.4 vs. 23.1 vs. 0.0%, p = 0.043). Conclusions: Families with non-US citizen or LEP caregivers were at highest risk of being lost-to-follow-up, but if engaged, were more likely to utilize resources. These findings indicate the need for larger studies to determine how to prevent loss-to-follow-up among immigrant and LEP caregivers participating in SDH screening programs.
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Affiliation(s)
- Omolara T Uwemedimo
- Department of Pediatrics, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, NY, United States.,Department of Occupational Medicine, Epidemiology and Prevention, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, Hempstead, NY, United States.,GLOhBAL (Global Learning Optimizing Health Building Alliances Locally) at Cohen Children's Medical Center of New York, New Hyde Park, NY, United States
| | - Hanna May
- Wellesley College, Wellesley, MA, United States
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Bezem J, Heinen D, Reis R, Buitendijk SE, Numans ME, Kocken PL. Improving access to school health services as perceived by school professionals. BMC Health Serv Res 2017; 17:743. [PMID: 29149903 PMCID: PMC5693589 DOI: 10.1186/s12913-017-2711-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 11/07/2017] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND The organisation of health assessments by preventive health services focusing on children's health and educational performance needs to be improved due to evolving health priorities such as mental health problems, reduced budgets and shortages of physicians and nurses. We studied the impact on the school professionals' perception of access to school health services (SHS) when a triage approach was used for population-based health assessments in primary schools. The triage approach involves pre-assessments by SHS assistants, with only those children in need of follow-up being assessed by a physician or nurse. The triage approach was compared with the usual approach in which all children are assessed by physicians and nurses. METHODS We conducted a cross-sectional study, comparing school professionals' perceptions of the triage and the usual approach to SHS. The randomly selected school professionals completed digital questionnaires about contact frequency, the approachability of SHS and the appropriateness of support from SHS. School care coordinators and teachers were invited to participate in the study, resulting in a response of 444 (35.7%) professionals from schools working with the triage approach and 320 (44.6%) professionals working with the usual approach. RESULTS Respondents from schools using the triage approach had more contacts with SHS and were more satisfied with the appropriateness of support from SHS than respondents in the approach-as-usual group. No significant differences were found between the two groups in terms of the perceived approachability of SHS. CONCLUSIONS School professionals were more positive about access to SHS when a triage approach to routine assessments was in place than when the usual approach was used. Countries with similar population-based SHS systems could benefit from a triage approach which gives physicians and nurses more opportunities to attend schools for consultations and assessments of children on demand.
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Affiliation(s)
- Janine Bezem
- Department of Preventive Youth Health Care, Municipal Health Service Gelderland-Midden, P.O. Box 5364, 6802 EJ Arnhem, The Netherlands
- Department of Child Health, TNO, P.O. Box 3005, 2301 DA Leiden, The Netherlands
| | - Debbie Heinen
- Department of Preventive Youth Health Care, Municipal Health Service Gelderland-Midden, P.O. Box 5364, 6802 EJ Arnhem, The Netherlands
| | - Ria Reis
- Department of Public Health and Primary Care, Leiden University Medical Centre (LUMC), P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Simone E. Buitendijk
- Education Office, Imperial College London, London SW7 2AZ, London, United Kingdom
| | - Mattijs E. Numans
- Department of Public Health and Primary Care, Leiden University Medical Centre (LUMC), P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Paul L. Kocken
- Department of Child Health, TNO, P.O. Box 3005, 2301 DA Leiden, The Netherlands
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Kumra T, Antani S, Johnson SB, Weaver SJ. Improving Adolescent Preventive Care in an Urban Pediatric Clinic: Capturing Missed Opportunities. J Adolesc Health 2017; 60:734-740. [PMID: 28259619 DOI: 10.1016/j.jadohealth.2017.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 11/23/2016] [Accepted: 01/05/2017] [Indexed: 11/17/2022]
Abstract
PURPOSE To increase the proportion of adolescents with Medicaid who receive preventive care services in an urban pediatric clinic. METHODS A quality improvement intervention was implemented at an urban pediatric primary care clinic between November 2013 and October 2014. The intervention systematically "flipped" acute visits into well-care visits for patients ages 12-21 years, when overdue. The primary process measure was the percentage of acute visits expanded to include well-care components out of total eligible opportunities. The primary outcome measure was adolescent well-care (AWC) completion in 2014 versus 2013 and 2012. RESULTS Among 857 adolescents with Medicaid, 124 additional AWC visits were completed by October 2014 compared to 2013 and 71 additional visits compared to 2012. The gap to achieving Healthcare Effectiveness Data and Information Set neutral zone targets for AWC was reduced by 59% compared to 2013 and by 54% compared to 2012. The mean proportion of eligible acute opportunities "flipped" monthly increased from 17% (range: 10%-21%) during the initial 3 months of implementation to 30% (range: 5%-50%) in the last 3 months. CONCLUSIONS Systematically flipping acute visits into well visits resulted in reaching Healthcare Effectiveness Data and Information Set quality targets for AWC, which had not previously been accomplished by this clinic. Incorporating staff and provider feedback strengthened intervention fidelity and buy-in despite time constraints in a busy, urban setting.
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Affiliation(s)
- Tina Kumra
- Johns Hopkins Community Physicians, Baltimore, Maryland; Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Health Policy & Management, Johns Hopkins School of Public Health, Baltimore, Maryland.
| | - Shweta Antani
- Department of Pediatrics, Columbia University Medical Center, New York, New York
| | - Sara B Johnson
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Department of Population Family & Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sallie J Weaver
- Department of Health Policy & Management, Johns Hopkins School of Public Health, Baltimore, Maryland; Department of Anesthesiology & Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
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40
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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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Hsu HC, Lee SY, Lai CM, Tsai WL, Chiu HT. Effects of Pediatric Anticipatory Guidance on Mothers of Young Children. West J Nurs Res 2016; 40:305-326. [DOI: 10.1177/0193945916681292] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Provision of anticipatory guidance to parents during well-child visits is a defining component of pediatric primary care. Using nationally representative data from the 2000 U.S. National Survey of Early Childhood Health, this study addressed the questions of whether, how, and what mothers of children below age 3 with different ethnic/racial background could benefit from anticipatory guidance. Structural equation modeling results showed that across ethnic/racial groups, guidance was directly associated with decreased maternal stress and directly and indirectly associated with effective parenting practices in child development, discipline, and safety. Moreover, guidance was consistently associated with decreased stress (effect size = .159/.123/.252) and increased effective parenting practices in child development (total effect = .090/.179/.296), discipline (total effect = .079/.138/.111), and safety (total effect = .186/.204/.229) in White/Black/Latino groups, respectively. Finally, whereas guidance was directly associated with child safety in all groups, it was indirectly contributed to child development and discipline via maternal stress in the Latino group only.
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Affiliation(s)
| | - Shih-Yu Lee
- University of Texas at Tyler, Tyler, TX, USA
| | - Chin-Man Lai
- Chung Shan Medical University Hospital, Taichung City, Taiwan
| | - Wan-Ling Tsai
- Taichung Veterans General Hospital and Hung Kuang University, Taichung City, Taiwan
| | - Hsiao-Tung Chiu
- Chung Shan Medical University Hospital, Taichung City, Taiwan
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Affiliation(s)
- Oskar G Jenni
- Child Development Center and the Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
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Machuca H, Arevalo S, Hackley B, Applebaum J, Mishkin A, Heo M, Shapiro A. Well Baby Group Care: Evaluation of a Promising Intervention for Primary Obesity Prevention in Toddlers. Child Obes 2016; 12:171-8. [PMID: 27035857 DOI: 10.1089/chi.2015.0212] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Nationally, approximately 24% of preschool children are overweight or obese, with low-income communities disproportionately affected. Few interventions to prevent obesity in children at greatest risk have demonstrated positive results. Therefore, we evaluated the effectiveness of a novel group well-child care intervention for primary obesity prevention at age 2 years. METHODS Well Baby Group (WBG) is an alternative to traditional well-child care offered at a federally qualified health center in the South Bronx. Facilitated by a pediatrician and nutritionist, WBG fosters positive dietary behaviors, responsive parenting and feeding practices, and peer support during the first 18 months of life. Multivariable logistic regression was conducted to test the effect of WBG on rates of overweight/obesity at 2 years (BMI-for-age ≥85th percentile) using a nonrandomized comparison group of children receiving traditional care at our center over the same period. RESULTS Characteristics of mothers and infants were comparable between intervention (n = 47) and comparison (n = 140) groups. Children enrolled in WBG were significantly less likely to be overweight/obese at 2 years than children receiving traditional well-child care (2.1% vs. 15.0%; OR 0.12; 95% CI 0.02-0.94; p = 0.02). In multivariable regression analysis, WBG remained a significant independent protective factor (OR 0.12; 95% CI 0.02-0.93; p = 0.04), adjusting for birthweight and parity. CONCLUSIONS WBG, a replicable model integrated into primary care visits, affords a unique opportunity to intervene consistently and early, providing families in at-risk communities with increased provider time, intensive education, and ongoing support. Further study of group well-child care for primary obesity prevention is warranted to confirm the effectiveness of the model.
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Affiliation(s)
- Hildred Machuca
- 1 Community Pediatric Programs, A Partnership of Montefiore and Children's Health Fund , Bronx, NY
| | - Sandra Arevalo
- 1 Community Pediatric Programs, A Partnership of Montefiore and Children's Health Fund , Bronx, NY
| | - Barbara Hackley
- 1 Community Pediatric Programs, A Partnership of Montefiore and Children's Health Fund , Bronx, NY
| | - Jo Applebaum
- 1 Community Pediatric Programs, A Partnership of Montefiore and Children's Health Fund , Bronx, NY
| | - Arielle Mishkin
- 1 Community Pediatric Programs, A Partnership of Montefiore and Children's Health Fund , Bronx, NY
| | - Moonseong Heo
- 2 Department of Epidemiology and Population Health, Albert Einstein College of Medicine , Bronx, NY
| | - Alan Shapiro
- 1 Community Pediatric Programs, A Partnership of Montefiore and Children's Health Fund , Bronx, NY
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Bourgeois N, Brauer P, Simpson JR, Kim S, Haines J. Interventions for prevention of childhood obesity in primary care: a qualitative study. CMAJ Open 2016; 4:E194-9. [PMID: 27398363 PMCID: PMC4933605 DOI: 10.9778/cmajo.20150081] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Preventing childhood obesity is a public health priority, and primary care is an important setting for early intervention. Authors of a recent national guideline have identified a need for effective primary care interventions for obesity prevention and that parent perspectives on interventions are notably absent from the literature. Our objective was to determine the perspectives of primary care clinicians and parents of children 2-5 years of age on the implementation of an obesity prevention intervention within team-based primary care to inform intervention implementation. METHODS We conducted focus groups with interprofessional primary care clinicians (n = 40) and interviews with parents (n = 26). Participants were asked about facilitators and barriers to, and recommendations for implementing a prevention program in primary care. Data were recorded and transcribed, and we used directed content analysis to identify major themes. RESULTS Barriers existed to addressing obesity-related behaviours in this age group and included a gap in well-child primary care between ages 18 months and 4-5 years, lack of time and sensitivity of the topic. Trust and existing relationships with primary care clinicians were facilitators to program implementation. Offering separate programs for parents and children, and addressing both general parenting topics and obesity-related behaviours were identified as desirable. INTERPRETATION Despite barriers to addressing obesity-related behaviours within well-child primary care, both clinicians and parents expressed interest in interventions in primary care settings. Next steps should include pilot studies to identify feasible strategies for intervention implementation.
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Affiliation(s)
- Nicole Bourgeois
- Department of Family Relations and Applied Nutrition (Bourgeois, Brauer, Randall Simpson, Haines), University of Guelph, Guelph, Ont.; Family Practice Health Centre (Bourgeois, Kim), Women's College Hospital; Department of Family and Community Medicine (Kim), University of Toronto, Toronto, Ont
| | - Paula Brauer
- Department of Family Relations and Applied Nutrition (Bourgeois, Brauer, Randall Simpson, Haines), University of Guelph, Guelph, Ont.; Family Practice Health Centre (Bourgeois, Kim), Women's College Hospital; Department of Family and Community Medicine (Kim), University of Toronto, Toronto, Ont
| | - Janis Randall Simpson
- Department of Family Relations and Applied Nutrition (Bourgeois, Brauer, Randall Simpson, Haines), University of Guelph, Guelph, Ont.; Family Practice Health Centre (Bourgeois, Kim), Women's College Hospital; Department of Family and Community Medicine (Kim), University of Toronto, Toronto, Ont
| | - Susie Kim
- Department of Family Relations and Applied Nutrition (Bourgeois, Brauer, Randall Simpson, Haines), University of Guelph, Guelph, Ont.; Family Practice Health Centre (Bourgeois, Kim), Women's College Hospital; Department of Family and Community Medicine (Kim), University of Toronto, Toronto, Ont
| | - Jess Haines
- Department of Family Relations and Applied Nutrition (Bourgeois, Brauer, Randall Simpson, Haines), University of Guelph, Guelph, Ont.; Family Practice Health Centre (Bourgeois, Kim), Women's College Hospital; Department of Family and Community Medicine (Kim), University of Toronto, Toronto, Ont
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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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Beck AF, Tschudy MM, Coker TR, Mistry KB, Cox JE, Gitterman BA, Chamberlain LJ, Grace AM, Hole MK, Klass PE, Lobach KS, Ma CT, Navsaria D, Northrip KD, Sadof MD, Shah AN, Fierman AH. Determinants of Health and Pediatric Primary Care Practices. Pediatrics 2016; 137:e20153673. [PMID: 26933205 DOI: 10.1542/peds.2015-3673] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/17/2015] [Indexed: 11/24/2022] Open
Abstract
More than 20% of children nationally live in poverty. Pediatric primary care practices are critical points-of-contact for these patients and their families. Practices must consider risks that are rooted in poverty as they determine how to best deliver family-centered care and move toward action on the social determinants of health. The Practice-Level Care Delivery Subgroup of the Academic Pediatric Association's Task Force on Poverty has developed a roadmap for pediatric providers and practices to use as they adopt clinical practice redesign strategies aimed at mitigating poverty's negative impact on child health and well-being. The present article describes how care structures and processes can be altered in ways that align with the needs of families living in poverty. Attention is paid to both facilitators of and barriers to successful redesign strategies. We also illustrate how such a roadmap can be adapted by practices depending on the degree of patient need and the availability of practice resources devoted to intervening on the social determinants of health. In addition, ways in which practices can advocate for families in their communities and nationally are identified. Finally, given the relative dearth of evidence for many poverty-focused interventions in primary care, areas that would benefit from more in-depth study are considered. Such a focus is especially relevant as practices consider how they can best help families mitigate the impact of poverty-related risks in ways that promote long-term health and well-being for children.
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Affiliation(s)
- Andrew F Beck
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio;
| | - Megan M Tschudy
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Tumaini R Coker
- Department of Pediatrics, David Geffen School of Medicine and Mattel Children's Hospital, Los Angeles, California
| | - Kamila B Mistry
- Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, Maryland; Agency for Healthcare Research and Quality; Rockville, Maryland
| | - Joanne E Cox
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Benjamin A Gitterman
- Department of Pediatrics, Children's National Health System; Washington, District of Columbia
| | - Lisa J Chamberlain
- Department of Pediatrics, Lucile Packard Children's Hospital, Palo Alto, California
| | - Aimee M Grace
- Office of US Senator Brian Schatz (D-HI) and George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Michael K Hole
- Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts
| | - Perri E Klass
- Department of Pediatrics, New York University School of Medicine, New York, New York
| | - Katherine S Lobach
- Department of Pediatrics, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York
| | - Christine T Ma
- Department of Pediatrics, UCSF Benioff Children's Hospital Oakland, Oakland, California
| | - Dipesh Navsaria
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Kimberly D Northrip
- Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky; and
| | - Matthew D Sadof
- Department of Pediatrics, Baystate Children's Hospital, Springfield, Massachusetts
| | - Anita N Shah
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Arthur H Fierman
- Department of Pediatrics, New York University School of Medicine, New York, New York
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Bezem J, Theunissen M, Kamphuis M, Numans ME, Buitendijk SE, Kocken P. A Novel Triage Approach to Identifying Health Concerns. Pediatrics 2016; 137:e20150814. [PMID: 26908683 DOI: 10.1542/peds.2015-0814] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We investigated the detection of health problems in preventive child health care (PCH) by a novel triage approach for routine health assessments. In the triage approach, all children were preassessed by a physician's assistant, and only those in need of follow-up were assessed by a PCH physician or nurse. In the traditional approach, all children were assessed by a PCH physician or nurse. METHODS A prospective cohort design was used with data on routine assessments of 1897 children aged 5 to 6 and 10 to 11 years. Primary outcomes were the detection of overweight, visual disorders, and psychosocial problems, with type of approach (traditional vs triage) as independent variable. To assess the severity of health problems, BMI, Snellen, Strengths and Difficulties Questionnaire, and Child Behavior Checklist, scores were compared for both approaches in subgroups of children with overweight, visual disorders, or psychosocial problems. RESULTS No significant differences were found between the approaches in terms of the detection of incident cases of overweight, visual disorders, and psychosocial problems. Significantly higher Strengths and Difficulties Questionnaire scores were found in the subgroup with psychosocial problems when the triage approach was used. Marginal differences between the approaches were found for severity of overweight in the subgroup of overweight children. CONCLUSIONS A novel triage approach to PCH resulting in less involvement of physicians and nurses in routine assessments appears to detect health problems as effectively as the traditional approach in place. More research is needed to determine the long-term outcomes of the 2 approaches.
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Affiliation(s)
- Janine Bezem
- Municipal Health Service Gelderland-Midden, Arnhem, Netherlands; Netherlands Organisation of Applied Scientific Research, Leiden, Netherlands;
| | - Meinou Theunissen
- Netherlands Organisation of Applied Scientific Research, Leiden, Netherlands
| | - Mascha Kamphuis
- Netherlands Organisation of Applied Scientific Research, Leiden, Netherlands
| | - Mattijs E Numans
- Department Public Health and Primary Care Leiden University Medical Centre, Leiden, Netherlands
| | | | - Paul Kocken
- Netherlands Organisation of Applied Scientific Research, Leiden, Netherlands; Department Public Health and Primary Care Leiden University Medical Centre, Leiden, Netherlands
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Jones MN, Brown CM, Widener MJ, Sucharew HJ, Beck AF. Area-Level Socioeconomic Factors Are Associated With Noncompletion of Pediatric Preventive Services. J Prim Care Community Health 2016; 7:143-8. [PMID: 26883436 DOI: 10.1177/2150131916632361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We examined 4872 infants born consecutively, 2011-2012, and seen at 3 primary care centers to determine whether area-based socioeconomic measures were associated with noncompletion of common preventive services within the first 15 months. Addresses were geocoded and linked to census tract poverty, adult educational attainment, and household vehicle ownership rates. The quartile of patients in the highest poverty (adjusted odds ratio [aOR] 1.25; 95% confidence interval [CI] 1.01-1.54) and lowest vehicle ownership tracts (aOR 1.32; 95% CI 1.07-1.63) had significantly increased odds of service noncompletion. There were significant spatial clusters of low completion in Cincinnati's urban core. These findings have implications for preventive service delivery.
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Affiliation(s)
- Margaret N Jones
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Courtney M Brown
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Heidi J Sucharew
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Andrew F Beck
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Abstract
In restructuring the delivery of primary care to improve the wellness of a community, every community must review its own circumstances for factors such as resources and capacities, health concerns, social and political perspectives, and competing priorities. Strengthening the health care team with community health workers to create a patient-centered medical home can enhance health care access and outcomes. Community health workers can serve as critical connectors between health systems and communities; they facilitate access to and improve quality and culturally sensitive medical care, emphasizing preventive and primary care.
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Affiliation(s)
- Sheri L Johnson
- Department of Pediatrics, Center for the Advancement of Underserved Children, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA
| | - Veronica L Gunn
- Department of Pediatrics, Center for the Advancement of Underserved Children, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA; Department of Pediatrics, Medical College of Wisconsin, Population Health Management, Children's Hospital of Wisconsin, PO Box 1997, C525, Milwaukee, WI 53201-1997, USA.
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Early Child Social-Emotional Problems and Child Obesity: Exploring the Protective Role of a Primary Care-Based General Parenting Intervention. J Dev Behav Pediatr 2015; 36:594-604. [PMID: 26375801 DOI: 10.1097/dbp.0000000000000212] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether early social-emotional problems are associated with child feeding practices, maternal-child feeding styles, and child obesity at age 5 years, in the context of a primary care-based brief general parenting intervention led by an integrated behavioral health specialist to offer developmental monitoring, on-site intervention, and/or referrals. METHODS A retrospective cohort study was conducted of mothers with 5-year-old children previously screened using the Ages and Stages Questionnaires: Social-Emotional (ASQ:SE) during the first 3 years of life. ASQ:SE scores were dichotomized "not at risk" versus "at risk." "At risk" subjects were further classified as participating or not participating in the intervention. Regression analyses were performed to determine relationships between social-emotional problems and feeding practices, feeding styles, and weight status at age 5 years based on participation, controlling for potential confounders and using "not at risk" as a reference group. RESULTS Compared with children "not at risk," children "at risk-no participation" were more likely to be obese at age 5 years (adjusted odds ratio, 3.12; 95% confidence interval, 1.03 to 9.45). Their mothers were less likely to exhibit restriction and limit setting and more likely to pressure to eat than mothers in the "not at risk" group. Children "at risk-participation" did not demonstrate differences in weight status compared with children "not at risk." CONCLUSION Early social-emotional problems, unmitigated by intervention, were related to several feeding styles and to obesity at age 5 years. Further study is needed to understand how a general parenting intervention may be protective against obesity.
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