title: Feasibility and Impact of Doctor-Nurse Task Delegation in Preventive Child Health Care in the Netherlands, a Controlled Before-After Study.
abstract: BACKGROUND
  In the Netherlands a need is felt for more flexible Child Health Care services, both efficient and tailored to needs. We set up a study on impact and feasibility of task delegation to child health care nurses performing all regular checkups on children aged 2 months to 4 years. Abnormal findings were discussed with the attending child health care doctor. This article describes impact and feasibility of this task delegation from four viewpoints: competences of nurses; percentage of children assigned to the nurse; change in abnormal findings and referrals; experiences of professionals and parents.
  
  
  METHODS
  Two experiment teams and two control teams were compared before and after starting task delegation. Nurses in the experiment teams were trained to carry out regular checkups on healthy children. Assignment to the experiment schedule was a joint decision by doctor and nurse. Nursing competences were measured by means of questionnaires. Percentage of children assigned to the nurse and screening results of eyes, heart, hips, growth and development were extracted from the electronic health record. Difference in change was compared between experiment and control teams. Mann-Whitney tests and logistic generalized estimating equations were used to test for significance. Experiences of professionals and parents were evaluated through focus group interviews, which were subjected to a qualitative analysis.
  
  
  RESULTS
  Nurses in the experiment regions showed improvement in medical screening skills. No difference in change was perceived in general nursing competences. In the experiment group, 69% of all children were assigned to the nurse. There were no significant differences in change in the percentages of abnormal findings or referrals in the experiment teams compared to the control teams, except for hips. Interviews showed that both doctors and nurses thought positively of the new working method, yet made some recommendations for improvements. Parents felt well-informed and experienced an equal level of proficiency but less continuity in person.
  
  
  CONCLUSIONS
  This experiment shows that task delegation from doctor to nurse in preventive child health care is feasible. It is important to pay attention to the acceptation process of professionals during implementation. More investigation is needed in order to assess effectiveness and efficacy of task delegation.
authors.affiliation: Icare JGZ, Blankenstein 400, P.O. box 900, 7940 KE, Meppel, the Netherlands.
authors.forename: S Janine
authors.initials: SJ
authors.lastname: Benjamins
authors.affiliation: Icare JGZ, Blankenstein 400, P.O. box 900, 7940 KE, Meppel, the Netherlands.
authors.forename: Maurice L W
authors.initials: ML
authors.lastname: Damen
authors.affiliation: Department of Health Technology Assessment, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, P.O. box 85500, 3508 GA, Utrecht, the Netherlands.
authors.forename: Henk F
authors.initials: HF
authors.lastname: van Stel
mesh_terms: D000067576:Child Health; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D065187:Controlled Before-After Studies; D032022:Delegation, Professional; D057286:Electronic Health Records; D005240:Feasibility Studies; D005260:Female; D017144:Focus Groups; D006801:Humans; D007223:Infant; D007400:Interprofessional Relations; D008297:Male; D015233:Models, Statistical; D009426:Netherlands; D009726:Nurses; D010290:Parents; D010358:Patient Participation; D010372:Pediatrics / Q000379:methods; D010820:Physicians; D012017:Referral and Consultation; D011795:Surveys and Questionnaires; D000078329:Workforce