@article{ref1,
title="Well-Child Care Clinical Practice Redesign for Serving Low-Income Children",
journal="Pediatrics",
year="2014",
author="Coker, Tumaini R. and Moreno, Candice and Shekelle, Paul G. and Schuster, Mark A. and Chung, Paul J.",
volume="134",
number="1",
pages="e229-39",
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 &quot;Community Advisory Boards&quot; [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. <br><br>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.<p /> <p>Language: en</p>",
language="en",
issn="0031-4005",
doi="10.1542/peds.2013-3775",
url="http://dx.doi.org/10.1542/peds.2013-3775"
}