Well-Child Care (WCC) visits for child preventive health care during the first three years of life are criticalbecause they may be the only opportunity before a child reaches preschool to identify and address importantsocial, developmental, behavioral, and health issues that could have significant impact and long-lasting effectson children's lives as adults. Unfortunately, this opportunity is often missed for children in low-incomecommunities. The structure of WCC in the U.S. cannot support the vast array of WCC needs of thesevulnerable children and their families. Key structural problems include (a) reliance on physicians for basic,routine preventive care services, (b) limitation to a 15-minute face-to-face clinician-directed well-visit for thewide array of education and guidance services needed, and (c) lack of a systematic, patient-driven method forvisit customization to meet families' needs. These structural problems contribute to the wide variations inprocesses of care and preventive care outcomes, resulting in poorer quality of WCC and perhaps worse healthoutcomes. We previously used a rigorous, structured community-based participatory approach guided by keyWCC stakeholders and expert panel methods to develop and test a new, innovative model of WCC delivery tomeet the needs of children in low-income communities: Parent-focused Redesign for Encounters,Newborns to Toddlers (PARENT). PARENT is a team-based approach to care using a health educator(?Parent Coach?) to provide the bulk of WCC services, address specific needs faced by families in low-incomecommunities, and decrease reliance on the clinician as the primary provider of WCC services. In an initial pilotrandomized controlled trial of PARENT among 251 low-income families in two urban area pediatric practices,we found strong and consistent intervention effects on the quality of preventive care provided to families, andon reducing emergency department (ED) utilization. A larger trial of PARENT with multiple clinics isneeded to position PARENT as an evidence-based, financially sustainable model for WCC delivery thatcan be implemented by practices and clinics nationwide. In a clinic-randomized controlled trial of PARENT,we will examine parent-reported quality of care and healthcare utilization (e.g., ED utilization), conduct a costanalysis, and use direct observations to assess changes in physician time allocation with Parent Coach-ledwell-visits. The study will be conducted in partnership with 12 clinics and their health plan payers, and addressthe following Specific Aims:
Aim #1 : Measure the effect of PARENT on receipt of nationally-recommended WCC services and parentexperiences of care.
Aim #2 : Determine the effects of PARENT on WCC, urgent care, and ED utilization, and on net costs.
Aim #3 : Examine the effect of PARENT on physician time allocation for WCC and urgent care visits.
Aim #4 : Assess the effect of PARENT on parent-focused outcomes in an exploratory analysis.
This Parent Coach-led model for preventive care is an innovative; comprehensive preventive care deliverymodel that has shown promising preliminary findings suggesting that it may be a more effective system for thedelivery of family-centered; comprehensive preventive care for young children in low-income communities. Thislarge pragmatic trial of the Parent Coach-led model of care in partnership with community practices and theirpayers (health plans) will assess its utility as an evidence-based and financially sustainable model for thedelivery of preventive care services to children in low-income communities.
