New designs for well-child visits

Two innovative models of well-child care (WCC) for low-income children that rely on less time with a physician and more with a health educator are described in a new study. The models and the process by which they were developed may be useful to other private practices and clinics serving publicly insured children, the study suggests.

Researchers working with a multisite community health center and 2 small private practices that served mostly children on Medicaid designed a structured process to create a new format for well-child visits for children aged from birth to 3 years. Community Advisory Boards (CABs), comprised of clinicians, staff, and parents from the community center and the private practices devised 4 models of WCC using data from WCC stakeholders, a systematic literature review, and a WCC framework created for the study. An expert panel then evaluated the models for potential effectiveness-based on receipt of recommended services, family-centeredness, timely and appropriate follow-up, and feasibility and efficiency-and each CAB selected a model to implement.

The CAB from the community health center chose a group-visit format; the private practice CAB chose an individual station-to-station plan. Both models included a brief visit with the physician for a physical examination and discussion of parents’ physical health concerns. Both relied on a health educator to provide anticipatory guidance and developmental, behavioral, and psychosocial screening and surveillance. Both models also used electronic previsit questionnaires to ascertain parent concerns and set up scheduled communications between parents and the healthcare team by text or phone.

In the group-visit format, 6 to 9 parent-child pairs met with the health educator for 2 hours at each age-specific well-child visit, with the physician available for most of that time. A physical exam; measurements (by a medical assistant); and standard development, autism, and psychosocial screening were done at the beginning of the session, followed by discussion and anticipatory guidance with the health educator and any needed immunizations given by the medical assistant.

The 40-minute station-to-station format comprised 10 minutes with the physician followed by anticipatory guidance with the health educator, and measurements and immunizations performed by a medical assistant. Parents completed standardized screening tools in the waiting room before the visit.

The researchers note that the models will need to be tested in various setting to evaluate their effect on child/family outcomes. They suggest that the models, and the process they created to develop them, may help other small practices and clinics that want to redesign their well-child visits.

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