title: Parent-reported quality of preventive care for children at-risk for developmental delay.
abstract: OBJECTIVE
  To compare preventive care quality for children at risk and not at risk for developmental, behavioral, or social delays.
  
  
  METHODS
  Using the 2007 National Survey of Children's Health (n = 22,269), we used the Parents' Evaluation of Developmental Status (PEDS) questionnaire to identify children ages 10 months to 5 years who were at risk for delays. We examined parent-reported quality measures to evaluate whether care was comprehensive, coordinated, family-centered, effective in providing developmental surveillance and screening, and provided within a medical home. Bivariate and multivariate analyses were used.
  
  
  RESULTS
  Twenty-eight percent of children were at-risk for delay, with 17% at moderate risk and 11% at high risk. Greater proportions of children at high, moderate, and no/low risk had a usual source of care (89%-96%) and a personal doctor/nurse (91%-94%); smaller proportions of children underwent a standardized developmental screening (16%-23%) and had parental developmental concerns elicited from their doctor (47%-48%). In adjusted analyses, moderate-risk and high-risk children were less likely than no/low-risk children to receive needed care coordination (adjusted odds ratio [AOR] for high risk 0.33, 95% confidence interval [95% CI] 0.24-0.46) and referrals (high risk AOR 0.40, 95% CI 0.25-0.65), family-centered care (high-risk AOR 0.47, 95% CI 0.36-0.62), and to have a medical home (high-risk AOR 0.41, 95% CI 0.32-0.54).
  
  
  CONCLUSIONS
  Our findings may reflect either poorer quality of care provided to at-risk children, or higher level of parental need that routine visits are not currently meeting. For at-risk children, enhanced screening and detection followed by targeted increases in communication and follow-up may help clinicians better anticipate families' needs.
authors: Department of Pediatrics, David Geffen School of Medicine and Mattel Children's Hospital at UCLA, Los Angeles, CA 90024, USA. tcoker@mednet.ucla.edu
authors: Tumaini R
authors: TR
authors: Coker
authors: Yahya
authors: Y
authors: Shaikh
authors: Paul J
authors: PJ
authors: Chung
mesh_terms: D016022:Case-Control Studies; D002662:Child Health Services / Q000706:statistics & numerical data*; D002675:Child, Preschool; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D002658:Developmental Disabilities / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D010290:Parents; D018802:Patient-Centered Care / Q000706:statistics & numerical data; D011315:Preventive Medicine / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000706:statistics & numerical data*