Pediatric Practice Redesign with Group Well Child Care Visits: A Multi-Site Study
Pediatric Practice Redesign with Group Well Child Care Visits: A Multi-Site Study
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DOI：
10.1007/s10995-021-03146-y
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发表时间：
2021-05-03
影响因子：
2.3
通讯作者：
Meyer, Dodi
中科院分区：
文献类型：
--
作者：
Friedman, Suzanne;Calderon, Bianca;Meyer, Dodi
在提供高效、有效的儿童保育方面存在多种障碍，特别是在低收入移民社区。实践重新设计战略，包括小组良好的儿童保育，已显示出改善护理服务和医疗保健成果的承诺。评估在多个城市，学术实践照顾服务不足，主要是移民儿童的一组良好的儿童保育计划的可行性，并评估与传统护理相比的健康结果和过程措施。方法前瞻性干预对照研究，招募参与者在出生后第一年内进行良好的儿童护理访视或传统访视。根据美国儿科学会（AAP）的建议设计了一个文化敏感的课程。通过患者调查和医疗记录信息分析过程和健康结果。结果101个家庭参加了集体护理，74个家庭参加了传统护理。团体护理参与者的所有推荐产后抑郁症筛查和家庭暴力筛查率较高（分别为65%和37%，38%和17%），预期指导保留率较高（67%和37%），患者对其提供者的满意度较高。团体护理的重新设计并没有增加在诊所花费的时间长度。结论实践组良好的儿童保育是一种可行的方法，实践重新设计，这使得增加心理社会筛查和预期的指导交付和保留相比，传统的访问，低收入，主要是移民家庭。父母对集体护理的满意度较高，这些访问提供了更多与提供者面对面的时间，而不会增加在实践中花费的时间。
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.