A New Model for the Delivery of Well-Child Care to Low-Income Children

描述（由申请人提供）：在生命的前3年，健康儿童的访问是至关重要的，因为他们可能是孩子到达学前班之前唯一的机会，以确定和解决重要的社会，发展，行为和健康问题。早期和积极关注这些问题可能会对健康，医疗保健成本和经济产生重大的长期效益。个人未能充分发挥其发展潜力或避免慢性衰弱性疾病，可能会对私营部门的生产力以及社会福利、刑事司法和保健系统造成严重损失。在我们目前的儿童保健制度中，往往错过了通过这些预防性保健服务及早采取积极行动的机会-许多儿童和家庭得不到这些重要的服务;低收入家庭的儿童往往最缺乏这种保健。鉴于在提供和接受良好儿童护理方面存在的这些缺陷，特别是对低收入儿童而言，儿科医生和研究人员已开始将“重新设计良好儿童护理”描述为儿童预防保健服务的变革议程。重新设计的努力旨在从根本上改变目前的护理系统，超越更温和和渐进的质量改进运动所能实现的目标。Coker博士以前的工作主要集中在从儿科医生，父母和健康计划的角度重新设计良好的儿童护理。在这个拟议的职业发展计划中，Coker博士将联合收割机结合社区参与式研究方法和专家小组方法，在可重复的模型构建过程中开发一种新的护理模式，满足低收入家庭的需求。具体来说，Coker博士将使用三个主要的儿童保育利益相关者群体的观点-提供者，父母和付款人（例如，健康计划）-设计和试点测试一种向0-3岁儿童提供良好儿童保健的新模式。这种新的护理模式将使用一个考虑替代护理结构的框架来开发：非医生提供者（护士，非专业健康教育工作者，社会工作者），非传统形式（团体访问，互联网，电话）和非临床地点（日托中心，家访，杂货店）提供良好的儿童护理服务。来自三个儿童保健利益相关者团体的意见将有助于创建一个以患者为中心的、可持续的、可在特定社区使用的模式。虽然各种社会经济群体的父母普遍需要全面的儿童保育，但低收入父母在我们目前的护理系统中往往有最大程度的未满足需求，并且可能从新的护理模式中受益最多。因此，将在主要是低收入父母的样本中对这种新的照料模式进行试点测试。Coker博士作为Robert Wood约翰逊临床学者在卫生服务研究方面发展了技能，并作为普通儿科医生在儿童预防服务方面发展了技能。她将通过获得卫生服务设计和规划，以社区为基础的参与性研究，专家小组方法和成本分析的新知识和研究技能建立在这种教育背景。为了实现这些职业发展目标，她将充分利用加州大学洛杉矶分校和兰德公司提供给她的丰富资源，参加研究生课程，全国会议和研究研讨会;通过研究和临床活动寻求体验式学习;并接受经验丰富的教师的指导，包括她的主要研究导师，博士。在拟议的职业发展期结束时，Coker博士将具备必要的技能，继续作为独立调查员研究儿童保健重新设计，以便对我们的儿童保健系统进行可持续的结构性变革，从而更有效地向低收入家庭提供这些关键的早期预防性卫生服务。 公共卫生相关性：这一拟议的项目将产生一种专门为低收入家庭的需要提供护理的新模式。它还将产生一个明确的和可复制的模型构建过程，可用于改善儿科及其他领域的预防性卫生服务。

DESCRIPTION (provided by applicant): Well-child visits during the first 3 years of life are critical because they may be the only opportunity before a child reaches preschool to identify and address important social, developmental, behavioral, and health issues. Early and aggressive attention to these issues may have substantial long-term benefits for health, health care costs, and the economy. The failure of individuals to reach their full developmental potential or to avoid chronic debilitating diseases may generate crippling costs both to private sector productivity and to the social welfare, criminal justice, and health care systems. In our current system of well-child care, the opportunity for early and aggressive action through these preventive health services is often missed -- many children and families do not receive these important services; these deficiencies in care are often greatest for children in low-income families. In light of these deficiencies in the delivery and receipt of well-child care, especially for low-income children, pediatricians and researchers have begun to describe "well-child care redesign" as an agenda for change in child preventive health services. Efforts toward redesign aim to radically alter the current system of care beyond what more modest and incremental quality improvement campaigns can achieve. Dr. Coker's previous work has focused on well-child care redesign from the perspectives of pediatricians, parents, and health plans. In this proposed career development plan, Dr. Coker will combine a community-based participatory research approach with expert panel methods in a reproducible model-building process to develop a new model of care that meets the needs of low-income families. Specifically, Dr. Coker will use the perspectives of three major well-child care stakeholder groups-providers, parents, and payors (e.g., health plans)-to design and pilot test a new model for the delivery of well-child care to children ages 0-3. This new model of care will be developed using a framework that considers alternative structures for care: non-physician providers (nurses, lay health educators, social workers), non-traditional formats (group visits, internet, phone), and non-clinical locations (daycare centers, home visits, grocery stores) for well-child care services. Input from the three well-child care stakeholder groups will help to create a model that is patient-centered, sustainable, and feasible for use in a specific community. While the need for comprehensive well child care is universal among parents of various socioeconomic groups, low-income parents often have the greatest levels of unmet need in our current system of care, and may benefit most from a new model of care. This new model of care will therefore be pilot-tested among a sample of primarily low-income parents. Dr. Coker developed skills in health services research as a Robert Wood Johnson Clinical Scholar and in child preventive services as a general pediatrician. She will build upon this educational background by gaining new knowledge and research skills in health services design and planning, community-based participatory research, expert panel methods, and cost analysis. To achieve these career development goals, she will take full advantage of the wealth of resources available to her at UCLA and RAND to engage in graduate-level coursework, national meetings, and research seminars; seek experiential learning through research and clinical activities; and receive mentorship from experienced faculty, including her primary research mentor, Dr. Jos¿ J. Escarce. At the end of the proposed career development period, Dr. Coker will have the necessary skills to continue research in well-child care redesign as an independent investigator in order to make sustainable structural changes to our well-child care system that can result in more effective delivery of these critical early preventive health services to low-income families. PUBLIC HEALTH RELEVANCE: This proposed project will result in a new model for the delivery of care designed specifically for the needs of low-income families. It will also result in an explicit and reproducible model-building process that can be used to improve the delivery of preventive health services in pediatrics and beyond.