title: Well-child care clinical practice redesign for serving low-income children.
abstract: Our objective was to conduct a rigorous, structured process to create a new model of well-child care (WCC) in collaboration with a multisite community health center and 2 small, independent practices serving predominantly Medicaid-insured children. Working groups of clinicians, staff, and parents (called "Community Advisory Boards" [CABs]) used (1) perspectives of WCC stakeholders and (2) a literature review of WCC practice redesign to create 4 comprehensive WCC models for children ages 0 to 3 years. An expert panel, following a modified version of the Rand/UCLA Appropriateness Method, rated each model for potential effectiveness on 4 domains: (1) receipt of recommended services, (2) family-centeredness, (3) timely and appropriate follow-up, and (4) feasibility and efficiency. Results were provided to the CABs for selection of a final model to implement. The newly developed models rely heavily on a health educator for anticipatory guidance and developmental, behavioral, and psychosocial surveillance and screening. Each model allots a small amount of time with the pediatrician to perform a brief physical examination and to address parents' physical health concerns. A secure Web-based tool customizes the visit to parents' needs and facilitates previsit screening. Scheduled, non-face-to-face methods (text, phone) for parent communication with the health care team are also critical to these new models of care. A structured process that engages small community practices and community health centers in clinical practice redesign can produce comprehensive, site-specific, and innovative models for delivery of WCC. This process, as well as the models developed, may be applicable to other small practices and clinics interested in practice redesign.
authors.affiliation: UCLA Children's Discovery and Innovation Institute, Mattel Children's Hospital, andRAND, Santa Monica, California; tcoker@mednet.ucla.edu.
authors.forename: Tumaini R
authors.initials: TR
authors.lastname: Coker
authors.affiliation: University of Illinois College of Medicine, Chicago, Illinois;
authors.forename: Candice
authors.initials: C
authors.lastname: Moreno
authors.affiliation: RAND, Santa Monica, California;Department of Internal Medicine, West Los Angeles VA Hospital, Los Angeles, California;Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California;
authors.forename: Paul G
authors.initials: PG
authors.lastname: Shekelle
authors.affiliation: Division of General Pediatrics, Boston Children's Hospital, Boston, Massachusetts;Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; and.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schuster
authors.affiliation: UCLA Children's Discovery and Innovation Institute, Mattel Children's Hospital, andRAND, Santa Monica, California;Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Chung
mesh_terms: D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017146:Models, Organizational; D011203:Poverty; D014481:United States
keywords: practice redesign; preventive care; well-child care