Prevalence of Injuries Among Medicaid Enrolled Infants Prior to Child Abuse and Neglect

Prior research has identified common injuries among children who experience child maltreatment; however, most of this work has focused on inpatient settings and has excluded many cases of neglect. This study examines the prevalence of injuries that occur prior to a diagnosis of child maltreatment, as well as the proportion of children with well-child visits prior to the injury and child maltreatment diagnosis. Based on a secondary analysis of Medicaid data from four states, we found that among infants with 12 months of continuous enrollment ( N = 4817), 30.6% of those diagnosed with maltreatment were previously diagnosed with an injury. Among infants diagnosed with child maltreatment, 88.4% had at least one well-child visit prior to the maltreatment diagnosis. Among children with a maltreatment diagnosis and a prior injury, 84% had at least one well-child visit preceding the injury. These results indicate that most children had at least one well-child visit prior to being diagnosed with child maltreatment or an injury, indicating opportunities for prevention.

Promoting social emotional development during the paediatric well-child visit: a demonstration project

Supporting social emotional development, beginning at birth, can improve lifelong health. The American Academy of Paediatrics recommends 12 well-child visits between birth and age 3 years. Each well-child visit provides a unique opportunity to interact with and support families to promote social emotional development of children. Eighteen US paediatric practices joined a learning community to use improvement science to test and implement evidence-informed strategies that nurture parent–child relationships and promote the social emotional development of young children.Quality improvement methods were used to integrate 11 strategies into well-child visits between birth and age 3 years and measure the improvements with a set of outcome, process and balancing measures. Participation among the 18 paediatric practices was high with 72% of teams attending monthly webinars and 97% of teams attending the three learning sessions. Over 12 months, the percentage of children receiving age-appropriate social emotional development screens at participating practices’ well-child visits increased from a baseline median of 83% to 93%.Current paediatric practice in the USA focuses primarily on cognitive and physical development, and paediatric providers are less familiar with established practices to screen for social emotional development and promote the caregiver–child relationship. This project suggests that improvement methods show promise in increasing the number of children who receive age-appropriate social emotional development screens or assessments at well-child visits.

The Effect of Well Child Visit Location on Preventative Dental Visit

Recent emphasis has been placed on the integration of dental and medical primary care in an effort to promote recommendations from both American Academy of Pediatrics (AAP) and American Academy of Pediatric Dentistry (AAPD) that highlight the importance of preventing, intervening, and managing oral disease in childhood. The study aims to provide a population level insight into the role of location of service of medical well-child visit (WCV) and its association to preventative dental visit (PDV) for children between the ages of 0–20 years. Administrative claims data for 3.17 million Medicaid-enrolled children aged 0 to 20 years of age in 13 states in 2016 and 2017 were identified from the IBM Watson MarketScan Medicaid Database. Descriptive and survival analysis reveals most Medicaid enrolled children receive their WCV at an office and hospital, as compared to federally qualified health center, or rural or public health clinic. Further, this study demonstrates increased utilization of dental preventive services for children who receive a WCV. Hispanic children, female children, and children 5–9 years of age had a higher rate of PDV after a WCV at all three locations. This study contributes to the understanding of medical-dental integration among Medicaid-enrolled children and offers insight into the promotion of oral health prevention within medical primary care.

Ambiente e Salute News n.11 - settembre-ottobre 2021

Less is more: measuring body temperature during well child visits is not good for the child A recent retrospective study found the risk of prescribing unnecessary tests and therapies to the child in case of routine fever measurement during the well child visit. The article of the month discusses the need to offer clinical pathways based on evidence-based medicine.

Rural Disparities in Early Childhood Well Child Visit Attendance

PurposeChildren should attend well child visits (WCVs) during early childhood so that developmental disorders may be identified as early as possible, and if indicated treatment can begin. The aim of this research was to determine if rurality impacts access to WCV during early childhood, and if altering rurality measurement methods impacts outcomes.Design and MethodsWe utilized a longitudinal correlational design with early childhood data gathered from the Virginia All Payer Claims Database, which contains claims data from Medicaid and the majority of Virginia commercial insurance payers (n=6349). WCV attendance was evaluated against three rurality metrics: a traditional metric using Rural-Urban Commuting Area codes, a developed land variable, and a distance to care variable, at a zip code level.ResultsTwo of the rurality methods revealed that rural children attend fewer WCVs than their urban counterparts, (67% vs. 50% respectively, using a traditional metric; and a 0.035 increase in WCV attendance for every percent increase in developed land). Differences were attenuated by insurance payer; children with Medicaid attend fewer WCVs than those with private insurance.ConclusionsYoung children in rural Virginia attend fewer WCVs than their non-rural counterparts, placing them at higher risk for missing timely developmental disorder screenings. The coronavirus disease pandemic has been associated with an abrupt and significant reduction in vaccination rates, which likely indicates fewer WCVs and concomitant developmental screenings. Pediatric nurses should encourage families of young children to develop a plan for continued WCVs, so that early identification of developmental disorders can be achieved.

A Retrospective Comparison of Self-Scheduled to Staff-Scheduled Well-Child Appointments: Differences in Appointment Outcomes, After-Hours Access to Scheduling, and Appointment Requests (Preprint)

BACKGROUND Online booking of flights, hotels, and sports events has become commonplace in the travel and entertainment industry, but online self-scheduling of healthcare appointments is not yet widely used. An electronic health record (EHR) that integrates appointment scheduling and patient online access to medical records creates an opportunity for patient self-scheduling. Mayo Clinic developed and implemented a feature in its Patient Online Services (POS) web and mobile platform that allows software managed self-scheduling of well-child visits. OBJECTIVE We examined the use of a new self-scheduling appointment feature within POS in both web and mobile formats and determined use characteristics, outcomes, and efficiency of self-scheduling compared to staff-scheduling. METHODS Within a primary care setting, we collected 13 months of all appointment activity for the well-child visit for children ages 2 through 12. As these specific appointment types are for minors, self-scheduling is performed by parents or other proxies. We compared the appointment actions of scheduling and canceling for both the self-scheduled and staff-scheduled appointments. The frequency that patients were using self-scheduling outside of normal business hours was quantified and we compared ‘no-show’ outcomes of finalized appointments. RESULTS Of 1099 patients who performed any self-scheduling actions, 73.1% (803/1099) exclusively used the self-scheduling and self-canceling software. For those with access to self-scheduling (patients registered to Mayo Clinic POS), 4.92% (1201/24,417) of all well-child appointment scheduling actions were self-scheduled. Staff-scheduling required more than a single appointment step (e.g., schedule, cancel, reschedule) in 28.32% (3729/13,168) compared with only 7.01% (53/712) of self-scheduled appointments (P < .0001). Self-scheduling appointment actions took place outside of regular business hours 29.5% of the time (354/1201). No-shows accounted for 3.07% (28/912) of the self-scheduled finalized appointments compared to 4.12% (693/16,828) of staff-scheduled, a non-significant difference at P =.112. Staff-scheduled finalized appointments (that allowed for appointments greater than 12 weeks in the future) revealed a potential demand of 11.15% (1876/16,828) for appointments with longer lead times. CONCLUSIONS Self-scheduling can generate a significant number of finalized appointments, decreasing the need for staff scheduler time. About 30% of self-scheduling activity took place outside of usual staff scheduler hours, adding convenience value to the scheduling process. Over 90% of exclusive self-schedulers created a finalized appointment with a single appointment scheduling step. No-show rates were not adversely impacted by self-scheduling.