title: A Novel Triage Approach to Identifying Health Concerns.
abstract: BACKGROUND
  We investigated the detection of health problems in preventive child health care (PCH) by a novel triage approach for routine health assessments. In the triage approach, all children were preassessed by a physician's assistant, and only those in need of follow-up were assessed by a PCH physician or nurse. In the traditional approach, all children were assessed by a PCH physician or nurse.
  
  
  METHODS
  A prospective cohort design was used with data on routine assessments of 1897 children aged 5 to 6 and 10 to 11 years. Primary outcomes were the detection of overweight, visual disorders, and psychosocial problems, with type of approach (traditional vs triage) as independent variable. To assess the severity of health problems, BMI, Snellen, Strengths and Difficulties Questionnaire, and Child Behavior Checklist, scores were compared for both approaches in subgroups of children with overweight, visual disorders, or psychosocial problems.
  
  
  RESULTS
  No significant differences were found between the approaches in terms of the detection of incident cases of overweight, visual disorders, and psychosocial problems. Significantly higher Strengths and Difficulties Questionnaire scores were found in the subgroup with psychosocial problems when the triage approach was used. Marginal differences between the approaches were found for severity of overweight in the subgroup of overweight children.
  
  
  CONCLUSIONS
  A novel triage approach to PCH resulting in less involvement of physicians and nurses in routine assessments appears to detect health problems as effectively as the traditional approach in place. More research is needed to determine the long-term outcomes of the 2 approaches.
authors.affiliation: Municipal Health Service Gelderland-Midden, Arnhem, Netherlands; Netherlands Organisation of Applied Scientific Research, Leiden, Netherlands; janine.bezem@vggm.nl.
authors.forename: Janine
authors.initials: J
authors.lastname: Bezem
authors.affiliation: Netherlands Organisation of Applied Scientific Research, Leiden, Netherlands;
authors.forename: Meinou
authors.initials: M
authors.lastname: Theunissen
authors.affiliation: Netherlands Organisation of Applied Scientific Research, Leiden, Netherlands;
authors.forename: Mascha
authors.initials: M
authors.lastname: Kamphuis
authors.affiliation: Department Public Health and Primary Care Leiden University Medical Centre, Leiden, Netherlands.
authors.forename: Mattijs E
authors.initials: ME
authors.lastname: Numans
authors.affiliation: Leiden University, Leiden, Netherlands; and.
authors.forename: Simone E
authors.initials: SE
authors.lastname: Buitendijk
authors.affiliation: Netherlands Organisation of Applied Scientific Research, Leiden, Netherlands; Department Public Health and Primary Care Leiden University Medical Centre, Leiden, Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Kocken
mesh_terms: D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis; D002662:Child Health Services / Q000592:standards; D002675:Child, Preschool; D006297:Health Services Accessibility; D006801:Humans; D050177:Overweight / Q000175:diagnosis; D010823:Physician Assistants; D011314:Preventive Health Services / Q000379:methods / Q000592:standards; D011446:Prospective Studies; D011787:Quality of Health Care; D011795:Surveys and Questionnaires; D014218:Triage / Q000379:methods*; D014786:Vision Disorders / Q000175:diagnosis