Abstract：
OBJECTIVE:To describe the delivery of well-child care and its components; to compare that delivery with recommendations in Bright Futures; and to compare delivery of well-child care for children with special health care needs with that for children without special needs. METHODS:Over a 10-week period, 2 medical students observed and documented characteristics of well-child care visits by general pediatricians and midlevel pediatric providers. Parents completed a demographic questionnaire and a screener for children with special health care needs. RESULTS:A total of 483 visits by 43 pediatricians and 9 midlevel providers with patients from 0 to 19 years of age were observed. Adjusted mean visit duration was 20.3 minutes; 38.9% of visits began with an open-ended question about parent/child concerns. A mean of 7.2 health supervision/anticipatory guidance topics were addressed per visit. Clinicians addressed a mean of 42% of Bright Futures-recommended age-specific health supervision/anticipatory guidance topics. Topics addressed less frequently than recommended included family support, parental well-being, behavior/discipline, physical activity, media screen time, risk reduction/substance use, puberty/sex, social-peer interactions, and violence. Shorter visits were associated with asking about parent/child concerns and with addressing greater proportions of recommended health supervision/anticipatory guidance topics. Well-child care visits with children with special health care needs were 36% longer than those with children without special needs and addressed similar numbers of age-specific health supervision/anticipatory guidance topics. More time was spent with children with special health care needs addressing health supervision/anticipatory guidance topics, other conditions (usually their chronic condition), and testing, prescriptions, and referrals. CONCLUSIONS:Utilizing direct observation of visits with pediatric clinicians, we found that solicitation of parent/child concerns occurred less frequently than recommended. Fewer than half of recommended visit-specific health supervision/anticipatory guidance topics were addressed, and there was little congruence with some Bright Futures age group-specific recommendations. Notably, both solicitation of patient/parent concerns and greater adherence to health supervision/anticipatory guidance recommendations were associated with shorter visits. Well-child care visits with children with special health care needs were longer than those with children without special needs; more time was spent addressing similar numbers of health supervision/anticipatory guidance topics as well as their chronic conditions.
journal_name
Acad Pediatrjournal_title
Academic pediatricsauthors
Norlin C,Crawford MA,Bell CT,Sheng X,Stein MTdoi
10.1016/j.acap.2010.12.008subject
Has Abstractpub_date
2011-01-01 00:00:00pages
18-26issue
1eissn
1876-2859issn
1876-2867pii
S1876-2859(10)00353-0journal_volume
11pub_type
杂志文章abstract：OBJECTIVE:To examine the relationship between continuity of care for children with medical complexity (CMC) and emergency department (ED) utilization, care coordination quality, and family effects related to care coordination. METHODS:We measured ED utilization and primary care continuity with the Bice-Boxerman contin...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2018.04.009
更新日期：2018-08-01 00:00:00
abstract：OBJECTIVE:To examine whether infrequent bullying perpetration and victimization (once or twice a month) are associated with elevated levels of internalizing and externalizing problems and to assess evidence for a minimum frequency threshold for bullying involvement. METHODS:The analytic sample included 128,681 6th, 9t...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2013.02.004
更新日期：2013-05-01 00:00:00
abstract：BACKGROUND AND PURPOSE:The coming years could be a watershed period for children and health care as the nation implements the most significant federal health care legislation in 50 years: the Accountable Care Act (ACA). A year earlier, the American Recovery and Reinvestment Act (ARRA) set up a framework and road map fo...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2010.10.003
更新日期：2011-05-01 00:00:00
abstract：OBJECTIVE:An innovative low-cost parenting intervention, implemented through health services in Jamaica showed benefits to children's cognitive development at 18 months and parent's attitudes concerning childcare. We assessed the impact of the intervention on child and parent outcomes at 6 years of age. METHODS:A clus...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2021.01.003
更新日期：2021-01-09 00:00:00
abstract：OBJECTIVE:To identify the proportion of patients previously diagnosed with apparent life-threatening events (ALTE) who would meet criteria for brief resolved unexplained events (BRUE) and to identify rates of adverse outcomes in subgroups: ALTE not meeting criteria for BRUE, lower-risk BRUE, and higher-risk ALTE. METH...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2019.08.001
更新日期：2019-01-01 00:00:00
abstract：:Tobacco use is the leading cause of preventable death in the United States, and exposure to tobacco smoke harms children from conception forward. There is no safe level of tobacco exposure. Although overall smoking rates have declined, the advent of new products, such as electronic cigarettes, threatens to perpetuate ...
journal_title：Academic pediatrics
pub_type： 杂志文章,评审
doi：10.1016/j.acap.2016.12.010
更新日期：2017-04-01 00:00:00
abstract：BACKGROUND:Many pediatric residents suffer from burnout. We aimed to describe the prevalence, source, and epidemiology of bullying, discrimination, harassment, and physical violence, and the relationship between these experiences and burnout. METHODS:We analyzed data from the Spring, 2019 Pediatric Resident Burnout an...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2020.02.023
更新日期：2020-01-01 00:00:00
abstract：:Management of referral and consultation is an entrustable professional activity for pediatric residents; however, few tools exist to teach these skills. We designed and implemented tools to prompt discussion, feedback, and reflection about the process of referral, notably including the family's perspective. ...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2018.01.010
更新日期：2018-04-01 00:00:00
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journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2020.08.020
更新日期：2020-09-03 00:00:00
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journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2010.03.003
更新日期：2010-07-01 00:00:00
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journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2015.06.002
更新日期：2016-03-01 00:00:00
abstract：OBJECTIVE:Incorporating culturally sensitive care into well-child visits may help address pediatric preventive care disparities faced by racial and ethnic minorities, families with limited English proficiency, and immigrants. We explored parents' perspectives about the extent to which their children's pediatric care is...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2019.12.007
更新日期：2020-03-01 00:00:00
abstract：BACKGROUND:Given the high prevalence of asthma and obesity in minority children, there is a need to identify targets for intervention to decrease the impact of these conditions on children's functioning in this high-risk group. OBJECTIVE:To examine in urban children with persistent asthma, 1) differences in asthma ind...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2019.07.001
更新日期：2020-01-01 00:00:00
abstract：OBJECTIVE:The Core Entrustable Professional Activities for Entering Residency (Core EPAs) were developed to address the gap between medical school and residency. There is a lack of instruments to measure performance of the Core EPAs in clerkships. We describe the operationalization and outcomes of a workplace-based ass...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2020.09.016
更新日期：2020-10-07 00:00:00
abstract：BACKGROUND:The American Board of Pediatrics requires that pediatricians be able to initiate stabilization of a newborn. After residency, 45% of general pediatricians routinely attend deliveries. However, there is no standard approach or tool to measure resident proficiency in newborn resuscitation across training progr...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2018.09.004
更新日期：2019-01-01 00:00:00
abstract：OBJECTIVE:Accurate parental weight perception of one's child is an important step in addressing healthy behaviors, but its associations with socioeconomic status (SES) and household food insecurity (HFI) are unclear. We aimed to assess the association of parental weight perception with HFI. METHODS:This was a secondar...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2019.04.009
更新日期：2020-03-01 00:00:00
abstract：OBJECTIVE:Previous research suggests that cognitive functioning is associated with the risk of several adult psychiatric disorders. In this study we investigated whether adolescents who perform worse than expected at secondary school are at a higher risk for general mental health problems. METHODS:In a cross-sectional...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2017.04.016
更新日期：2017-08-01 00:00:00
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journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2011.05.001
更新日期：2011-09-01 00:00:00
abstract：OBJECTIVE:To evaluate how parents and physicians perceive the utility of a comprehensive, electronic previsit screener, and to assess its impact on the visit. METHODS:A mixed methods design was used. English-speaking parents were recruited from 3 primary care systems (urban MD and rural NY and VT) when they presented ...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2013.04.005
更新日期：2013-07-01 00:00:00
abstract：BACKGROUND:There are limited training opportunities for pediatricians in caring for children with medical complexity (CMC) in the home and community. Prior studies have described a lack of comfort caring for CMC among pediatric residents. OBJECTIVE:1) To evaluate the impact of participation in a virtual home visit cur...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2020.05.001
更新日期：2020-01-01 00:00:00
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journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2008.12.006
更新日期：2009-03-01 00:00:00
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journal_title：Academic pediatrics
pub_type： 杂志文章,多中心研究
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更新日期：2018-08-01 00:00:00
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journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2015.04.038
更新日期：2016-01-01 00:00:00
abstract：OBJECTIVE:To describe influences on shared decision making between primary care pediatricians and parents of young children with autism spectrum disorder (ASD). METHODS:We conducted a qualitative study using key informant interviews with 20 pediatricians of varying experience from 10 primary care practices and 20 Engl...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2016.04.007
更新日期：2016-08-01 00:00:00
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journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2012.05.003
更新日期：2012-09-01 00:00:00
abstract：OBJECTIVE:A parent-child relational framework was used as a method to train pediatric residents in basic knowledge and observation skills for the assessment of child development. Components of the training framework and its preliminary validation as an alternative to milestone-based approaches are described. METHODS:P...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2016.09.005
更新日期：2017-01-01 00:00:00
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journal_title：Academic pediatrics
pub_type： 杂志文章,评审
doi：10.1016/j.acap.2021.01.007
更新日期：2021-01-21 00:00:00
abstract：OBJECTIVE:Validated questionnaires help community pediatric services to identify emotional and behavioral problems (EBPs). This study assesses the psychometric properties of the self-report version of the Strengths and Difficulties Questionnaire (SDQ) for the identification of EBPs in adolescents (13 to 14years old) an...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2018.12.008
更新日期：2019-01-01 00:00:00
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journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2015.12.011
更新日期：2016-04-01 00:00:00
abstract：OBJECTIVE:To estimate the prevalence of use of fetal-harm drugs among women who received postpartum care in hospitals in Haiti and to identify groups of women at higher risk for potentially harmful medication exposures. METHODS:Women who received postpartum care in 2 large hospitals in Port-au-Prince, Haiti, from Augu...
journal_title：Academic pediatrics
pub_type： 杂志文章
doi：10.1016/j.acap.2010.09.003
更新日期：2010-11-01 00:00:00
