Patient centered improvement of well-child care: developing and evaluating the impact of patient-centered interventions to improve quality and equity of recommended services

Project Number: R40 MC 08959-02
Project Date: 2/1/2008
Grantee: Oregon Health and Sciences University
Department/Center: Department of Pediatrics/CAHMI

Final Report

Pending

Principal Investigator

Christina Bethell Ph.D.,
Director, Oregon Health and Sciences University Department of Pediatrics/CAHMI,
Department of Pediatrics/CAHMI 707 S.W. Gaines Street Mailcode: CDRC-P
Portland, Oregon 97239
bethellc@ohsu.edu

Abstract

This study proposes to implement and evaluate three patient-centered interventions with potential to improve the quality and equity of nationally recommended well-child care services for young children. These services are: (1) provision of anticipatory guidance and parental education on priority physical care, injury prevention and child development topics; (2) child developmental surveillance and addressing parental concerns; (3) assessment of the parent and family for risks to a child’s well-being and development; and (4) provision of care that is family-centered. Communication with the parent is the primary means through which these services are provided. Therefore, effective partnership with parents is essential. The three interventions are (1) Global Feedback: A tailored report provided to clinicians using aggregate data collected from parents about the quality and equity of the well-child care services these clinicians provide; (2) Shared Encounter: Use of an individualized, shared encounter form completed by parents in the waiting room and used to facilitate partnership between parents and pediatric clinicians during well-child care visits; and (3) Enhanced Encounter: Use of an online assessment and education module completed by parents, before the visit at home or in the waiting room, that yields a personalized guide (including educational resources) for parents and pediatric clinicians to review before and during well-child care visits. Interventions will be evaluated in three pediatric office study sites (urban and rural), two of which have an electronic medical record. Each site will implement one of the three interventions and will serve as its own control, using a quasi-experimental, pre and post intervention evaluation study design. The feasibility, acceptability and impact of interventions on the quality and equity of the well-child care services noted above will be evaluated using qualitative (informant interviews, focus groups) and quantitative (parent and clinician surveys; office system tracking data) data collected before, during and after interventions are implemented. Results will be disseminated through two papers appropriate for peer-reviewed journals and targeted communications with clinicians, parents and policymakers. Effective tools will be publicly available to clinicians and parents. In addition to numerous Healthy People 2010 objectives for promoting the health of children, this project addresses two Maternal and Child Health Bureau strategic research priorities: (1) quality improvement for maternal and child health (MCH) populations (issue #3) and (2) promoting the healthy development of MCH populations (issue #4). Priorities are addressed by developing evidence on how pediatric clinicians can partner with patients to translate nationally recommended well-child care services into practice in a patient-centered manner. The quality and equity of the services of focus here are of increased importance nationally, due to significant evidence regarding the relationship between these services and young children’s readiness for school and success in life, coupled with substantial evidence of the gap between recommended services and what is actually provided to young children and their families. The long-term objective is to advance implementation of patient-centered strategies that enhance the value and efficiency of well-child care services to promote the healthy development of young children.

Publications

Pending

Keywords

Well Child Care; Early Childhood Development, Family-Centered Quality Improvement, Patient-Provider Partnerships