title: Well-child care clinical practice redesign at a community health center: provider and staff perspectives.
abstract: BACKGROUND
  Community health centers (CHCs) are a key element of the health care safety net for underserved children. They may be an ideal setting to create well-child care (WCC) clinical practice redesign to drastically improve WCC delivery.
  
  
  OBJECTIVE
  To examine the perspectives of clinical and administrative staff at a large, multisite urban CHC on alternative ways to deliver WCC services for low-income children aged 0 to 3 years.
  
  
  METHODS
  Eight semistructured interviews were conducted with 4 pediatric teams (each consisting of 1 pediatrician and 2 medical assistants) and 4 CHC executive/administrative staff (Medical Director, COO, CEO, and Nurse Supervisor). Discussions were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis. Salient themes included WCC delivery challenges and endorsed WCC clinical practice redesign solutions.
  
  
  RESULTS
  The 3 main WCC delivery challenges included long wait times due to insurance verification and intake paperwork, lack of time for parent education and sick visits due to WCC visit volume, and absence of a system to encourage physicians to use non-face-to-face communication with parents. To address WCC delivery challenges, CHC providers and administrators endorsed several options for clinical practice redesign in their setting. These included use of a health educator in a team-based model of care, a previsit tool for screening and surveillance, Web site health education, a structured system for non-face-to-face (eg, phone) parent communication, and group visits.
  
  
  CONCLUSIONS
  CHC-specific strategies for WCC clinical practice redesign endorsed by a large, multisite safety net clinic may lead to more efficient, effective, and family-centered WCC for low-income populations.
authors: David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors: Kelly
authors: K
authors: Mooney
authors: Candice
authors: C
authors: Moreno
authors: Paul J
authors: PJ
authors: Chung
authors: Jacinta
authors: J
authors: Elijah
authors: Tumaini R
authors: TR
authors: Coker
mesh_terms: D000288:Administrative Personnel; D001291:Attitude of Health Personnel; D002140:California; D002662:Child Health Services / Q000458:organization & administration* / Q000592:standards; D002669:Child Welfare; D002675:Child, Preschool; D003153:Community Health Services / Q000458:organization & administration* / Q000592:standards; D003695:Delivery of Health Care / Q000458:organization & administration*; D006801:Humans; D007223:Infant; D008507:Medically Underserved Area; D011204:Poverty Areas; D011795:Surveys and Questionnaires
keywords: children; community health centers; preventive care; primary care; qualitative methods