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

为低收入儿童提供良好儿童保育的新模式

• 批准号: 8112527
• 负责人: Tumaini Rucker Coker
• 金额: $ 13.31万
• 依托单位: UNIVERSITY OF CALIFORNIA LOS ANGELES
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-15 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8112527
• 关键词: Active Learning; Address; After-Hours Care; Age; Attention; Behavioral; Care given by nurses; Caring; Child; Child Care; Chronic; Clinical; Communities; Cost Analysis; Criminal Justice; Data; Development; Development Plans; Developmental Delay Disorders; Disease; Educational Background; Faculty; Failure; Family; Federally Qualified Health Center; Future; Goals; Health; Health Benefit; Health Care Costs; Health Educators; Health Planning; Health Services; Health Services Research; Healthcare; Healthcare Systems; Home visitation; House Call; Immunization; Individual; Internet; Knowledge; Laboratories; Lead; Left; Life; Light; Location; Low income; Mentors; Mentorship; Methodology; Methods; Modeling; Nursery Schools; Parents; Pediatrics; Physicians; Preventive; Preventive Health Services; Private Sector; Process; Productivity; Research; Research Personnel; Resources; Sampling; Screening procedure; Services; Social Welfare; Social Workers; Structure; Supervision; System; Telephone; Testing; Time; Training; Visit; Wood material; Work; behavioral health; care delivery; care systems; career development; community based participatory research; cost; design; experience; financial incentive; improved; meetings; patient oriented; pediatrician; psychosocial; public health relevance; skills; social; socioeconomics; success; tool

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.

描述（由申请人提供）：在生命的前3年对儿童进行良好的探访是至关重要的，因为这可能是儿童进入幼儿园之前识别和解决重要的社会、发展、行为和健康问题的唯一机会。对这些问题的早期和积极关注可能对健康、医疗保健成本和经济有实质性的长期好处。个人未能充分发挥其发展潜力或未能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、刑事司法和卫生保健系统造成严重代价。在我们目前的儿童保健体系中，经常错过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些照料。鉴于在提供和接受儿童保健服务，特别是低收入儿童保健服务方面存在的这些缺陷，儿科医生和研究人员已开始将“重新设计儿童保健服务”描述为改变儿童预防性保健服务的议程。重新设计的努力旨在从根本上改变当前的护理系统，而不是更适度和渐进式的质量改进运动所能达到的。Coker博士以前的工作集中在从儿科医生、父母和健康计划的角度重新设计儿童保健。在这项拟议的职业发展计划中，Coker博士将在一个可重复的模型建立过程中，将社区参与性研究方法与专家小组方法结合起来，开发一种满足低收入家庭需要的新的护理模式。具体来说，Coker博士将从三个主要的儿童保育利益相关者群体——提供者、父母和付款人（例如，健康计划）——的角度来设计和试验一种新的模式，为0-3岁的儿童提供良好的儿童保育。这种新的护理模式将使用一个框架来开发，该框架考虑了其他护理结构：非医生提供者（护士、非专业卫生教育工作者、社会工作者）、非传统形式（小组访问、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、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，但在我们目前的护理体系中，低收入父母的需求往往是最大的，他们可能从一种新的护理模式中受益最多。因此，这种新的护理模式将在主要是低收入父母的样本中进行试点测试。Coker博士作为Robert Wood Johnson临床学者在卫生服务研究方面发展了技能，作为普通儿科医生在儿童预防服务方面发展了技能。她将以这一教育背景为基础，在卫生服务设计和规划、社区参与性研究、专家小组方法和成本分析方面获得新的知识和研究技能。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为她提供的丰富资源，参加研究生水平的课程、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，Jos¿J. Escarce博士。在建议的职业发展期结束时，Coker博士将拥有必要的技能，以独立调查员的身份继续研究儿童保育重新设计，以便对我们的儿童保育系统进行可持续的结构变革，从而更有效地向低收入家庭提供这些关键的早期预防性健康服务。