Gaps in well-child care attendance among primary care clinics serving low-income families

Elizabeth R. Wolf, Camille J. Hochheimer, Roy T. Sabo, Jennifer Devoe, Richard Wasserman, Erik Geissal, Douglas J. Opel, Nate Warren, Jon Puro, Jennifer O'Neil, James Pecsok, Alex H. Krist

Research output: Contribution to journalArticle

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Abstract

BACKGROUND AND OBJECTIVES: It is unclear which specific well-child visits (WCVs) are most frequently missed and whether age-specific patterns of attendance differ by race or insurance type. METHODS: We conducted a retrospective cohort study of children 0 to 6 years old between 2011 and 2016 within 2 health networks spanning 20 states. WCVs were identified by using International Classification of Diseases, Ninth and 10th Revisions and Current Procedural Terminology codes. We calculated adherence to the 13 American Academy of Pediatrics-recommended WCVs from birth to age 6 years. To address data completeness, we made 2 adherence calculations after a child's last recorded WCV: 1 in which we assumed all subsequent WCVs were attended outside the network and 1 in which we assumed none were. RESULTS: We included 152 418 children in our analysis. Most children were either publicly insured (77%) or uninsured (14%). The 2-, 4-, and 6-month visits were the most frequently attended (63% [assuming no outside care after the last recorded WCV] to 90% [assuming outside care]), whereas the 15-and 18-months visits (41%-75%) and 4-year visit (19%-49%) were the least frequently attended. Patients who were publicly insured and uninsured (versus privately insured) had higher odds of missing WCVs. Hispanic and Asian American (versus non-Hispanic white) patients had higher odds of attending WCVs. DISCUSSION The 15-and 18-month WCVs as well as the 4-year WCV are the least frequently attended WCVs. The former represent opportunities to identify developmental delays, and the latter represents an opportunity to assess school readiness.

Original languageEnglish (US)
Article numbere20174019
JournalPediatrics
Volume142
Issue number5
DOIs
StatePublished - Nov 1 2018

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Child Care
Primary Health Care
Current Procedural Terminology
Asian Americans
International Classification of Diseases
Insurance
Hispanic Americans
Cohort Studies

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Wolf, E. R., Hochheimer, C. J., Sabo, R. T., Devoe, J., Wasserman, R., Geissal, E., ... Krist, A. H. (2018). Gaps in well-child care attendance among primary care clinics serving low-income families. Pediatrics, 142(5), [e20174019]. https://doi.org/10.1542/peds.2017-4019

Gaps in well-child care attendance among primary care clinics serving low-income families. / Wolf, Elizabeth R.; Hochheimer, Camille J.; Sabo, Roy T.; Devoe, Jennifer; Wasserman, Richard; Geissal, Erik; Opel, Douglas J.; Warren, Nate; Puro, Jon; O'Neil, Jennifer; Pecsok, James; Krist, Alex H.

In: Pediatrics, Vol. 142, No. 5, e20174019, 01.11.2018.

Research output: Contribution to journalArticle

Wolf, ER, Hochheimer, CJ, Sabo, RT, Devoe, J, Wasserman, R, Geissal, E, Opel, DJ, Warren, N, Puro, J, O'Neil, J, Pecsok, J & Krist, AH 2018, 'Gaps in well-child care attendance among primary care clinics serving low-income families', Pediatrics, vol. 142, no. 5, e20174019. https://doi.org/10.1542/peds.2017-4019
Wolf, Elizabeth R. ; Hochheimer, Camille J. ; Sabo, Roy T. ; Devoe, Jennifer ; Wasserman, Richard ; Geissal, Erik ; Opel, Douglas J. ; Warren, Nate ; Puro, Jon ; O'Neil, Jennifer ; Pecsok, James ; Krist, Alex H. / Gaps in well-child care attendance among primary care clinics serving low-income families. In: Pediatrics. 2018 ; Vol. 142, No. 5.
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abstract = "BACKGROUND AND OBJECTIVES: It is unclear which specific well-child visits (WCVs) are most frequently missed and whether age-specific patterns of attendance differ by race or insurance type. METHODS: We conducted a retrospective cohort study of children 0 to 6 years old between 2011 and 2016 within 2 health networks spanning 20 states. WCVs were identified by using International Classification of Diseases, Ninth and 10th Revisions and Current Procedural Terminology codes. We calculated adherence to the 13 American Academy of Pediatrics-recommended WCVs from birth to age 6 years. To address data completeness, we made 2 adherence calculations after a child's last recorded WCV: 1 in which we assumed all subsequent WCVs were attended outside the network and 1 in which we assumed none were. RESULTS: We included 152 418 children in our analysis. Most children were either publicly insured (77{\%}) or uninsured (14{\%}). The 2-, 4-, and 6-month visits were the most frequently attended (63{\%} [assuming no outside care after the last recorded WCV] to 90{\%} [assuming outside care]), whereas the 15-and 18-months visits (41{\%}-75{\%}) and 4-year visit (19{\%}-49{\%}) were the least frequently attended. Patients who were publicly insured and uninsured (versus privately insured) had higher odds of missing WCVs. Hispanic and Asian American (versus non-Hispanic white) patients had higher odds of attending WCVs. DISCUSSION The 15-and 18-month WCVs as well as the 4-year WCV are the least frequently attended WCVs. The former represent opportunities to identify developmental delays, and the latter represents an opportunity to assess school readiness.",
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AU - Wasserman, Richard

AU - Geissal, Erik

AU - Opel, Douglas J.

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N2 - BACKGROUND AND OBJECTIVES: It is unclear which specific well-child visits (WCVs) are most frequently missed and whether age-specific patterns of attendance differ by race or insurance type. METHODS: We conducted a retrospective cohort study of children 0 to 6 years old between 2011 and 2016 within 2 health networks spanning 20 states. WCVs were identified by using International Classification of Diseases, Ninth and 10th Revisions and Current Procedural Terminology codes. We calculated adherence to the 13 American Academy of Pediatrics-recommended WCVs from birth to age 6 years. To address data completeness, we made 2 adherence calculations after a child's last recorded WCV: 1 in which we assumed all subsequent WCVs were attended outside the network and 1 in which we assumed none were. RESULTS: We included 152 418 children in our analysis. Most children were either publicly insured (77%) or uninsured (14%). The 2-, 4-, and 6-month visits were the most frequently attended (63% [assuming no outside care after the last recorded WCV] to 90% [assuming outside care]), whereas the 15-and 18-months visits (41%-75%) and 4-year visit (19%-49%) were the least frequently attended. Patients who were publicly insured and uninsured (versus privately insured) had higher odds of missing WCVs. Hispanic and Asian American (versus non-Hispanic white) patients had higher odds of attending WCVs. DISCUSSION The 15-and 18-month WCVs as well as the 4-year WCV are the least frequently attended WCVs. The former represent opportunities to identify developmental delays, and the latter represents an opportunity to assess school readiness.

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