The Rourke Baby Record Infant/Child Maintenance Guide: do doctors use it, do they find it useful, and does using it improve their well-baby visit records?
BACKGROUND
The Rourke Baby Record (RBR) - http://www.rourkebabyrecord.ca - is a freely available evidence-based structured form for child health surveillance from zero to five years. Family physicians/general practitioners (FP/GPs) doing office based well-baby care in three Ontario Canada cities (London, Ottawa, and Toronto) were randomly sampled to study the prevalence and utility of the RBR and documentation of well-baby visits.


METHODS
Database with telephone confirmation was conducted to assess the prevalence of use of the RBR. Study Part 1: Questionnaire mailed to a random sample of 100 RBR users. Outcome measures were utility of, helpfulness of, and suggestions for the RBR. Descriptive analysis was employed. Study Part 2: Retrospective chart review of well-baby visits by 38 FP/GPs using student t-tests and factor analysis. Outcome measures were well-baby visit documentation of growth, nutrition, safety issues, developmental milestones, physical examination, and overall comprehensiveness.


RESULTS
The RBR was used by 78.5% (402/512) of successfully contacted FP/GPs who did well-baby care in these 3 cities. Study Part 1: Questionnaire respondents (N = 41/100) used the RBR in several ways, and found it most helpful for assessing healthy child development, charting/recording the visits, managing time effectively, addressing parent concerns, identifying health problems, and identifying high risk situations. The RBR was seen to be least helpful as a tool for managing or for referring identified health problems. Study Part 2: Charts from a total of 1,378 well-baby visits on 176 children were audited. Well-baby care provided by the 20 FP/GPs who used the RBR compared to that by the 18 non-users was statistically more likely to include documentation of type of feeding (p = 0.023), discussion of safety issues (p < 0.001), assessment of development (p = 0.001), and overall comprehensiveness (p < 0.001). Well-baby care provided by the RBR users compared to that by the non-users was not more likely to include documentation of measurement of growth (p = 0.097), or physical examination (p = 0.828).


CONCLUSIONS
The RBR was widely used by FP/GPs in these settings. RBR users found it helpful for many purposes, and had a consistently high rate of documentation of many aspects of well-baby care. The Rourke Baby Record has become a de facto gold standard clinical practice tool in knowledge translation for pediatric preventive medicine and health surveillance for primary care pediatric providers.
Rourke
Leslie
L
Discipline of Family Medicine, Faculty of Medicine, Memorial University of Newfoundland, St, John's, NL A1B 3V6, Canada. lrourke@mun.ca
Godwin
Marshall
M
Rourke
James
J
Pearce
Sarah
S
Bean
Joyce
J
D001291:Attitude of Health Personnel; D002662:Child Health Services; D002675:Child, Preschool; D055317:Evidence-Based Practice; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D007223:Infant; D007224:Infant Care / Q000379:methods* / Q000592:standards; D007231:Infant, Newborn; D008297:Male; D008485:Medical Audit; D008499:Medical Records; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D011322:Primary Prevention / Q000379:methods*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires