Redesigning Well-Child Care Visits

More efficient and effective models of well-child care (WCC) in low-income communities are needed. Researchers describe the structured process they used to develop new models of WCC based on feasibility, acceptability to parents and clinicians, and cost.

Community advisory boards (CABs) that included clinicians, staff, and parents from a multisite community health center and two private practices met to develop four WCC models for children aged 0 to 3 years. Models were based on stakeholder data, literature review of practice redesign, and a WCC framework offering alternative structures (including nonphysician providers, nontraditional formats, and nonclinical locations). An expert panel rated each model for provision of recommended services, family-centeredness, timely follow-up, feasibility, and efficiency. CABs reviewed results and selected a final model.

The community health center CAB selected a group-visit model, and the private practice CAB selected an individual station-to-station model. Both models involved a brief physical exam with a pediatrician or nurse practitioner and relied on a health educator for most routine WCC services. In the group model, six parent-child dyads met with the health educator for 2 hours at each age-specific WCC visit to review screening results, address parent concerns, engage in standard anticipatory guidance, and receive immunizations. The station-to-station model was scheduled for 40 minutes and involved 10 minutes with the physician, individual anticipatory guidance with a health educator, and measurements and immunizations taken by a medical assistant. Both models used electronic pre-visit questionnaires to identify parent concerns and scheduled text or phone communications with the healthcare team.