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.
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.
