A Parent Coach Model for Well-Child Care Among Low-Income Children: A Randomized Controlled Trial

作者：Coker Tumaini R^*; Chacon Sandra; Elliott Marc N; Bruno Yovana; Chavis Toni; Biely Christopher; Bethell Christina D; Contreras Sandra; Mimila Naomi A; Mercado Jeffrey; Chung Paul J

来源：Pediatrics, 2016, 137(3): e20153013.

DOI：10.1542/peds.2015-3013

OBJECTIVE: The goal of this study was to examine the effects of a new model for well-child care abstract (WCC), the Parent-focused Redesign for Encounters, Newborns to Toddlers (PARENT), on WCC quality and health care utilization among low-income families.
METHODS: PARENT includes 4 elements designed by using a stakeholder-engaged process: (1) a parent coach (ie, health educator) to provide anticipatory guidance, psychosocial screening and referral, and developmental/behavioral guidance and screening at each well-visit; (2) a Web-based tool for previsit screening; (3) an automated text message service to provide periodic, age-specific health messages to families; and (4) a brief, problem-focused encounter with the pediatric clinician. The Promoting Healthy Development Survey-PLUS was used to assess receipt of recommended WCC services at 12 months' postenrollment. Intervention effects were examined by using bivariate analyses.
RESULTS: A total of 251 parents with a child aged <= 12 months were randomized to receive either the control (usual WCC) or the intervention (PARENT); 90% completed the 12-month assessment. Mean child age at enrollment was 4.5 months; 64% had an annual household income less than $ 20 000. Baseline characteristics for the intervention and control groups were similar. Intervention parents scored higher on all preventive care measures (anticipatory guidance, health information, psychosocial assessment, developmental screening, and parental developmental/behavioral concerns addressed) and experiences of care measures (family-centeredness, helpfulness, and overall rating of care). Fifty-two percent fewer intervention children had >= 2 emergency department visits over the 12-month period. There were no significant differences in WCC or sick visits/urgent care utilization.
CONCLUSIONS: A parent coach-led model for WCC may improve the receipt of comprehensive WCC for low-income families, and it may potentially lead to cost savings by reducing emergency department utilization.

• 出版日期2016-3