Parent-reported quality of preventive care for children at-risk for developmental delay.

Abstract:

OBJECTIVE:To compare preventive care quality for children at risk and not at risk for developmental, behavioral, or social delays. METHODS:Using the 2007 National Survey of Children's Health (n = 22,269), we used the Parents' Evaluation of Developmental Status (PEDS) questionnaire to identify children ages 10 months to 5 years who were at risk for delays. We examined parent-reported quality measures to evaluate whether care was comprehensive, coordinated, family-centered, effective in providing developmental surveillance and screening, and provided within a medical home. Bivariate and multivariate analyses were used. RESULTS:Twenty-eight percent of children were at-risk for delay, with 17% at moderate risk and 11% at high risk. Greater proportions of children at high, moderate, and no/low risk had a usual source of care (89%-96%) and a personal doctor/nurse (91%-94%); smaller proportions of children underwent a standardized developmental screening (16%-23%) and had parental developmental concerns elicited from their doctor (47%-48%). In adjusted analyses, moderate-risk and high-risk children were less likely than no/low-risk children to receive needed care coordination (adjusted odds ratio [AOR] for high risk 0.33, 95% confidence interval [95% CI] 0.24-0.46) and referrals (high risk AOR 0.40, 95% CI 0.25-0.65), family-centered care (high-risk AOR 0.47, 95% CI 0.36-0.62), and to have a medical home (high-risk AOR 0.41, 95% CI 0.32-0.54). CONCLUSIONS:Our findings may reflect either poorer quality of care provided to at-risk children, or higher level of parental need that routine visits are not currently meeting. For at-risk children, enhanced screening and detection followed by targeted increases in communication and follow-up may help clinicians better anticipate families' needs.

journal_name

Acad Pediatr

journal_title

Academic pediatrics

authors

Coker TR,Shaikh Y,Chung PJ

doi

10.1016/j.acap.2012.05.003

subject

Has Abstract

pub_date

2012-09-01 00:00:00

pages

384-90

issue

5

eissn

1876-2859

issn

1876-2867

pii

S1876-2859(12)00138-6

journal_volume

12

pub_type

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