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: 7989887
• 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/7989887
• 关键词: Active Learning; Address; After-Hours Care; Age; Attention; Behavioral; 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; Guidelines; 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; Nurses; Parents; Pediatrics; Physicians; Preventive; Preventive Health Services; Private Sector; Process; Productivity; Provider; 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（由适用提供）：在生命的前三年中，孩子的访问至关重要，因为它们可能是孩子到达学龄前识别和解决重要的社会，发展，行为和健康问题之前的唯一机会。对这些问题的早期和积极关注可能会对健康，医疗保健成本和经济带来可观的长期收益。个人未能发挥其全部发育潜力或避免长期使人衰弱的疾病可能会给私营部门的生产力和社会福利，刑事司法和医疗保健系统带来剪裁成本。在我们当前的夫妇护理系统中，经常错过这些预防性健康服务的早期和积极行动的机会 - 许多儿童和家庭没有得到这些重要的服务；对于低收入家庭中的儿童，这些缺陷通常是最大的。并接受了幼体护理，尤其是对于低收入儿童，儿科医生和研究人员的收到，已经开始将“夫妇护理重新设计”描述为儿童预防性卫生服务变化的AGERNDA。重新设计的努力旨在从根本上改变当前的护理系统，超过更适度和渐进的质量改进运动可以实现的目标。 Coker博士以前的工作从儿科医生，父母和健康计划的角度重新设计了孩子的护理。在这个拟议的职业发展计划中，Coker博士将在可再现的模型建设过程中将基于社区的参与研究方法与专家小组方法相结合，以开发一种满足低收入家庭需求的新型护理模型。具体来说，科克博士将利用三个主要的夫妇保健利益相关者团体，父母和付款人（例如，健康计划）的观点来设计和试点测试新的模型，用于向0-3岁儿童提供夫妇护理。这种新的护理模型将使用一个考虑替代护理结构的框架开发：非医师提供者（护士，外行健康教育者，社会工作者），非传统格式（团体访问，互联网，电话）和非临床地点（日托中心，家庭访问，访问者，杂货店，杂货店），以供良好的企业服务服务。来自三个健康的孩子护理利益相关者群体的意见将有助于创建一个以患者为中心，可持续性且可在特定社区使用的模型。尽管各种社会经济群体的父母普遍存在全面的健康育儿，但低收入父母通常在我们当前的护理体系中具有最大的未满足需求，并且可能会从新的护理模式中受益最大。因此，这种新的护理模式将在原发性低收入父母的样本中进行试点测试。 Coker博士在Robert Wood Johnson的临床学者和儿童预防服务方面发展了卫生服务研究技能。她将通过获得卫生服务设计和计划，基于社区的参与研究，专家小组方法和成本分析的新知识和研究技能来以这种教育背景为基础。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可用的大量资源，从事研究生级课程，国家会议和研究中心；通过研究和临床活动寻求专家学习；并接受经验丰富的教师的心态，包括她的主要研究心态，Josquarce博士。在拟议的职业发展期结束时，Coker博士将具有必要的技能，以继续在Well Child Care重新设计中作为独立研究者进行研究，以便对我们的孩子护理系统进行可持续的结构性变化，这可以使这些关键的早期预防卫生服务更有效地提供给低收入家庭。 公共卫生相关性：这个拟议的项目将导致一种新的模型，用于提供专门针对低收入家庭需求的护理。这也将导致明确且可重复的模型建设过程，该过程可用于改善儿科及其他地区的预防保健服务的交付。