Well-Child Care Clinical Practice Redesign for Young Children: A Systematic Review of Strategies and Tools

PEDIATRICS 2013 Vol. 131 No. Supplement 1 March 1, pp. S5 -S25

Tumaini R. Coker, MD, MBA^a,^b,^c, 

Annika Windon, AB^d,

Candice Moreno, MD, MPH^a,^b, 

Mark A. Schuster, MD, PhD^e,^f, and

Paul J. Chung, MD, MS^a,^b,^c,^g

1. BACKGROUND AND OBJECTIVE: Various proposals have been made to redesign well-child care (WCC) for young children, yet no peer-reviewed publication has examined the evidence for these. The objective of this study was to conduct a systematic review on WCC clinical practice redesign for children aged 0 to 5 years.
   METHODS: PubMed was searched using criteria to identify relevant English-language articles published from January 1981 through February 2012. Observational studies, controlled trials, and systematic reviews evaluating efficiency and effectiveness of WCC for children aged 0 to 5 were selected. Interventions were organized into 3 categories: providers, formats (how care is provided; eg, non–face-to-face formats), and locations for care. Data were extracted by independent article review, including study quality, of 3 investigators with consensus resolution of discrepancies.
   RESULTS: Of 275 articles screened, 33 met inclusion criteria. Seventeen articles focused on providers, 13 on formats, 2 on locations, and 1 miscellaneous. We found evidence that WCC provided in groups is at least as effective in providing WCC as 1-on-1 visits. There was limited evidence regarding other formats, although evidence suggested that non-face-to-face formats, particularly web-based tools, could enhance anticipatory guidance and possibly reduce parents’ need for clinical contacts for minor concerns between well-child visits. The addition of a non–medical professional trained as a developmental specialist may improve receipt of WCC services and enhance parenting practices. There was insufficient evidence on nonclinical locations for WCC.
   CONCLUSIONS: Evidence suggests that there are promising WCC redesign tools and strategies that may be ready for larger-scale testing and may have important implications for preventive care delivery to young children in the United States.