Abstract
Objectives
Multiple barriers exist to delivering efficient, effective well child care, especially in low-income, immigrant communities. Practice redesign strategies, including group well child care, have shown promise in improving care delivery and healthcare outcomes. To assess the feasibility of a group well child care program at multiple urban, academic practices caring for underserved, mostly immigrant children, and to evaluate health outcomes and process measures compared to traditional care.
Methods
Prospective, intervention control study with participants recruited to group well child care visits or traditional visits during the first year of life. A culturally sensitive curriculum was designed based on American Academy of Pediatrics (AAP) recommendations. Process and health outcomes were analyzed via patient surveys and medical record information.
Results
One hundred and one families enrolled in group care and 74 in traditional care. Group care participants had higher rates of all recommended postpartum depression screening and domestic violence screening (65% vs 37%, 38% vs 17% respectively), higher anticipatory guidance retention (67% vs 37%) and higher patient satisfaction with their provider. The group care redesign did not increase length of time spent in clinic.
Conclusions for Practice
Group well child care is a feasible method for practice redesign, which allows for increased psychosocial screening and anticipatory guidance delivery and retention compared to traditional visits, for low income, predominantly immigrant families. Parental satisfaction with group care is higher and these visits provide greater face-to-face time with the provider, without increasing time spent in the practice.
Similar content being viewed by others
References
Avila, R. M., & Bramlett, M. D. (2013). Language and immigrant status effects on disparities in Hispanic children’s health status and access to health care. Maternal and Child Health Journal, 17(3), 415–423. https://doi.org/10.1007/s10995-012-0988-9
Bialostozky, A., McFadden, S. E., & Barkin, S. (2016). A novel approach to well-child visits for latino children under two years of age. Journal of Health Care for the Poor and Underserved, 27(4), 1647–1655. https://doi.org/10.1353/hpu.2016.0153
Bloomfield, J., & Rising, S. S. (2013). CenteringParenting: An innovative dyad model for group mother-infant care. Journal of Midwifery & Women’s Health, 58(6), 683–689. https://doi.org/10.1111/jmwh.12132
Coker, T. R., Windon, A., Moreno, C., Schuster, M. A., & Chung, P. J. (2013). Well-child care clinical practice redesign for young children: a systematic review of strategies and tools. Pediatrics, 131(Suppl 1), S5-25. https://doi.org/10.1542/peds.2012-1427c
Grigg, A., Shetgiri, R., Michel, E., Rafton, S., & Ebel, B. E. (2013). Factors associated with nonurgent use of pediatric emergency care among Latino families. Journal of the National Medical Association, 105(1), 77–84. https://doi.org/10.1016/s0027-9684(15)30088-2
Hagan, J. F., Shaw, J. S., & Duncan, P. M. (2017). Bright futures: Guidelines for health supervision of infants, children, and adolescents. (4th ed.). Itasca: American Academy of Pediatrics.
Halfon, N., Stevens, G. D., Larson, K., & Olson, L. M. (2011). Duration of a well-child visit: Association with content, family-centeredness, and satisfaction. Pediatrics, 128(4), 657–664. https://doi.org/10.1542/peds.2011-0586
Hochstein, M., Sareen, H., Olson, L., O’Connor, K., Inkelas, M., & Halfon, N. (2001). A comparison of barriers to the provision of developmental assessments and psychological screenings during pediatric health supervision. Pediatric Research, 49(24a), 17
Jones, K. A., Do, S., Porras-Javier, L., Contreras, S., Chung, P. J., & Coker, T. R. (2018). Feasibility and acceptability in a community-partnered implementation of centeringparenting for group well-child care. Academic Pediatric, 18(6), 642–649. https://doi.org/10.1016/j.acap.2018.06.001
Konrad, T. R., Link, C. L., Shackelton, R. J., Marceau, L. D., von dem Knesebeck, O., Siegrist, J., Arber, S., Adams, A., & McKinlay, J. B. (2010). It’s about time: Physicians’ perceptions of time constraints in primary care medical practice in three national healthcare systems. Medical Care, 48(2), 95–100. https://doi.org/10.1097/MLR.0b013e3181c12e6a
Moyer, V. A., & Butler, M. (2004). Gaps in the evidence for well-child care: A challenge to our profession. Pediatrics, 114(6), 1511–1521. https://doi.org/10.1542/peds.2004-1076
Nelson, C. S., Wissow, L. S., & Cheng, T. L. (2003). Effectiveness of anticipatory guidance: Recent developments. Current Opinion in Pediatrics, 15(6), 630–635
New York City Department of Health and Mental Hygiene. (2015). Retrieved March 17, 2017, from https://a816-health.nyc.gov/hdi/profiles/
New York City Department of Health and Mental Hygiene. Community Health Profiles. (2015). Retrieved March 17, 2017, from https://www1.nyc.gov/assets/doh/downloads/pdf/data/2018chp-mn12.pdf
Office of the New York State Comptroller Thomas P. DiNapoli. (2015). Retrieved March 17, 2017, from https://www.osc.state.ny.us/files/reports/osdc/pdf/report-2-2016.pdf
Okie, S. (2008). Innovation in primary care–staying one step ahead of burnout. New England Journal of Medicine, 359(22), 2305–2309. https://doi.org/10.1056/NEJMp0805759
Osborn, L. M. (1985). Group well-child care. Clinics in Perinatology, 12(2), 355–365
Osborn, L. M., & Woolley, F. R. (1981). Use of groups in well child care. Pediatrics, 67(5), 701–706
Page, C., Reid, A., Hoagland, E., & Leonard, S. B. (2010). WellBabies: Mothers’ perspectives on an innovative model of group well-child care. Family Medicine, 42(3), 202–207
Racine, A. D., & Davidson, A. G. (2002). Use of a time-flow study to improve patient waiting times at an inner-city academic pediatric practice. Archives of Pediatrics and Adolescent Medicine, 156(12), 1203–1209
Ramdas, K., & Darzi, A. (2017). Adopting innovations in care delivery—The case of shared medical appointments. New England Journal of Medicine, 376(12), 1105–1107. https://doi.org/10.1056/NEJMp1612803
Rosenthal, M. S., Lannon, C. M., Stuart, J. M., Brown, L., Miller, W. C., & Margolis, P. A. (2005). A randomized trial of practice-based education to improve delivery systems for anticipatory guidance. Archives of Pediatrics and Adolescent Medicine, 159(5), 456–463. https://doi.org/10.1001/archpedi.159.5.456
Rushton, F. E., & American Academy of Pediatrics Committee on Community Health Services. (2005). The pediatrician’s role in community paediatrics. Pediatrics, 115(4), 1092–1094. https://doi.org/10.1542/peds.2004-2680
Saysana, M., & Downs, S. M. (2012). Piloting group well child visits in pediatric resident continuity clinic. Clinical Pediatrics (Phila), 51(2), 134–139. https://doi.org/10.1177/0009922811417289
Schor, E. L. (2004). Rethinking well-child care. Pediatrics, 114(1), 210–216. https://doi.org/10.1542/peds.114.1.210
Sherbourne, C. D., & Stewart, A. L. (1991). The MOS social support survey. Social Science and Medicine, 32(6), 705–714. https://doi.org/10.1016/0277-9536(91)90150-b
Taylor, J. A., Davis, R. L., & Kemper, K. J. (1997). A randomized controlled trial of group versus individual well child care for high-risk children: maternal-child interaction and developmental outcomes. Pediatrics, 99(6), E9. https://doi.org/10.1542/peds.99.6.e9
Funding
No funding source.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Friedman, S., Calderon, B., Gonzalez, A. et al. Pediatric Practice Redesign with Group Well Child Care Visits: A Multi-Site Study. Matern Child Health J 25, 1265–1273 (2021). https://doi.org/10.1007/s10995-021-03146-y
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10995-021-03146-y