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（由申请人提供）：生命最初 3 年的健康儿童探视至关重要，因为这可能是儿童进入学前班之前识别和解决重要的社会、发育、行为和健康问题的唯一机会。注意避免这些问题可能会给健康、医疗保健成本和经济带来巨大的长期利益。个人未能充分发挥其发展潜力或患有慢性衰弱性疾病可能会对私营部门的生产力和经济造成严重损失。社会福利、刑事司法、在我们目前的儿童保健系统中，经常错过通过这些预防性保健服务采取早期积极行动的机会——许多儿童和家庭没有获得这些重要的服务；鉴于低收入家庭的儿童，特别是低收入儿童在提供和接受良好儿童保育方面存在的缺陷，儿科医生和研究人员已开始将“儿童保育重新设计”描述为一项变革议程。努力重新设计儿童预防保健服务。科克博士之前的工作重点是从儿科医生、家长和健康计划的角度重新设计儿童保健。在开发计划中，科克博士将在可重复的模型构建过程中将基于社区的参与性研究方法与专家小组方法相结合，以开发满足低收入家庭需求的新护理模式。三个专业的观点健康儿童保育利益相关者群体——提供者、家长和付款人（例如健康计划）——设计并试点测试一种为 0-3 岁儿童提供健康儿童保育的新模式。使用考虑替代护理结构的框架制定：非医生提供者（护士、非专业健康教育者、社会工作者）、非传统形式（团体访问、互联网、电话）和非临床地点（日托中心、家庭）三个儿童保健利益相关者团体的意见将有助于创建一个以患者为中心、可持续且可在特定社区使用的模式，同时需要全面的服务。良好的儿童保育在不同社会经济群体的父母中是普遍存在的，低收入父母在我们当前的保育体系中往往有最大程度的未满足需求，并且可能从新的保育模式中受益最多，因此，这种新的保育模式将是。在主要是低收入父母的样本中进行了试点测试。 Coker 博士作为罗伯特·伍德·约翰逊临床学者培养了卫生服务研究技能，并作为普通儿科医生培养了儿童预防服务技能。她将通过获得基于社区的卫生服务设计和规划方面的新知识和研究技能来巩固这一教育背景。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公司提供的丰富资源，参与研究生水平的课程、全国会议和研究研讨会；通过研究和寻求体验式学习临床活动；并接受经验丰富的教师的指导，包括她的主要研究导师 Jos¿ J. Escarce。在拟议的职业发展期结束时，Coker 博士将具备必要的技能，以独立研究者的身份继续研究儿童保健重新设计，以便对我们的儿童保健系统进行可持续的结构性变革，可以更有效地向低收入家庭提供这些重要的早期预防性卫生服务。 公共卫生相关性：该拟议项目将产生一种专门针对低收入家庭需求而设计的新的护理服务模式，还将产生一个可用于改善服务提供的明确且可重复的模型构建过程。儿科及其他领域的预防保健服务。