Measure 1: Children up-to-date with well child visits 

• Kids Get Care Results: Three clinics participating for two years increased their overall rate of two-year-olds up-to-date with well child visits by 22 percentage points, from 53% to 75%, representing 291 out of 379 young children.
• Associated evidence of cost effectiveness: Medicaid children who are up-to-date with well child checks have a 48% lower chance of having an avoidable hospitalization. (Hakim, Pediatrics, 2001) A CHARS analysis shows this equates to annual Medicaid savings of at least $591,893. (UW and KGC cost analysis, 2003)
  
  NOTE: As of 9/1/05, Kids Get Care sites are measuring Children up-to-date with well child visits at 15 months and 3 to 6 years, per HEDIS measures.

Measure 2: Application of fluoride varnishes on young children

• Kids Get Care results:
  • The 16 medical practices participating in the first year of the Children's Preventive Health Care Collaborative (CPHC) in 2005 achieved an aggregate 91% increase in the percentage of 1- to 4-year-old Medicaid patients receiving fluoride varnishes during a well child visit, from 22% in January to 42% in May 2005.
  • 9,360 applications of fluoride varnish were applied to children under five at eleven Kids Get Care participating clinical sites from 2003-2006.
    
    
• Associated evidence of cost effectiveness: Fluoride varnish has been demonstrated to reduce caries by 38%.(Centers for Disease Control and Prevention. Recommendations for using fluoride to prevent and control dental caries in the United States. MMWR 2001;50(No. RR-14):[21].) According to the Washington State Department of Health, dental care is the most frequent cause for treatment in the operating rooms of Children’s Hospital and Regional Medical Center. Hospital treatment of this sort can cost $4,500 per child. By contrast, the cost of three fluoride varnish applications per year per child, a preventive strategy to control early childhood caries, is approximately $40. A Washington Dental Service Foundation (WDSF) analysis shows potential savings of roughly $1.5 million statewide if fluoride varnishes were applied during well child visits for children ages zero to five instead of waiting to pay to fill the cavities that occur without this preventive treatment.

Measure 3: First oral health screening by first birthday

• Kids Get Care results:
  • 326% increase from 337 in ’05 to 1,434 in ’06 in children under 18 months who received an oral health visit in eight clinics (in one clinic 72 % of 15 month old medical clinic patients had received a dental visit).

Associated evidence of cost effectiveness: Children with early dental visits incur fewer subsequent dental costs. The age at the first preventive dental visit had a significant positive effect on dentally related expenditures, with the average dentally related costs being less for children who received earlier preventive care. The average dentally related costs per child according to age at the first preventive visit were as follows: before age 1, $262; age 1 to 2, $339; age 2 to 3, $449; age 3 to 4, $492; age 4 to 5, $546. (Savage, Pediatrics, 2004)

Measure: Use of structured developmental surveys such as Ages and Stages Questionnaire (ASQ) or Parent Evaluation of Developmental Status (PEDS).

• Kids Get Care Results: The 16 medical practices participating in the first year of the Children's Preventive Health Care Collaborative (CPHC) in 2005 achieved an aggregate 280% increase in the percentage of 1- to 4-year-olds receiving a structured developmental questionnaire (the ASQ or the PEDS) during a well-child visit increased from 10% in January to 38% in May.
  
  
• Associated evidence of cost effectiveness: ASQs can detect 70 to 80 percent of children with developmental problems. By contrast, typically only 30 percent of children with developmental issues are identified before they reach kindergarten (Palfrey et al., J Peds., 1994 and Squires et al., JDBP. 1996) This detection and subsequent early intervention reduces need for special education and other services later in life – 20% do not need special education services at 3 years of age. (Washington State Infant Toddler Early Intervention Program (ITEIP) data system)

The Kids Get Care Model is very flexible; as it gets adapted to the needs of communities and clinic sites, it has been used to measure a wide range of preventive and primary care health outcomes including immunizations, numbers of well child visits at all ages, screening and treatment for maternal depression and children’s mental health and referrals for dental, mental health and developmental services. New measure can easily be incorporated into the model.

Measure 4: Use of structured developmental surveys such as Ages and Stages Questionnaire (ASQ) or Parent Evaluation of Developmental Status (PEDS).

• Kids Get Care Results:
  • Four medical practices achieved an aggregate 160-fold increase in the number of children under five receiving a structured developmental questionnaire (the ASQ or the PEDS) during a well-child visit from 5 in 2004 to 807 in 2006.
    
    
  • The 16 medical practices participating in the first year of the Children's Preventive Health Care Collaborative (CPHC) in 2005 achieved an aggregate 280% increase in the percentage of 1- to 4-year-olds receiving a structured developmental questionnaire (the ASQ or the PEDS) during a well-child visit increased from 10% in January to 38% in May.
    
    
• Associated evidence of cost effectiveness: ASQs can detect 70 to 80 percent of children with developmental problems. By contrast, typically only 30 percent of children with developmental issues are identified before they reach kindergarten (Palfrey et al., J Peds., 1994 and Squires et al., JDBP. 1996) This detection and subsequent early intervention reduces need for special education and other services later in life – 20% do not need special education services at 3 years of age. (Washington State Infant Toddler Early Intervention Program (ITEIP) data system)

The Kids Get Care Model is very flexible; as it gets adapted to the needs of communities and clinic sites, it has been used to measure a wide range of preventive and primary care health outcomes including immunizations, numbers of well child visits at all ages, screening and treatment for maternal depression and children’s mental health and referrals for dental, mental health and developmental services. New measure can easily be incorporated into the model.