Healthy Steps for Young Children program in pediatric residency training: impact on primary care outcomes

Incorporating Healthy Steps for Young Children into pediatric practice has been shown to have positive effects for children and families. Although this model of care has also been integrated into several pediatric and family medicine training programs, published reports to date have focused only on residents' perceptions of their interactions with the model of care. In this study, we report the impact on primary care outcomes after integrating Healthy Steps for Young Children into residency training.

Continuity of care, longitudinal care in the practice, quality of primary care services, and rates of behavioral, developmental, and psychosocial diagnoses were measured for 3 cohorts: (1) Healthy Steps-enrolled children, (2) non-Healthy Steps-enrolled children who were followed at the same site of care, and (3) non-Healthy Steps-enrolled children who were receiving primary care at a similar residency training site within the same training program. All data were extracted from patient charts at the 2 practice sites.

Continuity of care was significantly better for Healthy Steps-enrolled children compared with non-Healthy Steps-enrolled children at the Healthy Steps site for both total visits and health maintenance visits. Longitudinal care and quality of primary care services did not differ within or between sites. The rates of documentation of behavioral, developmental, or psychosocial diagnoses did not differ between Healthy Steps-enrolled and non-Healthy Steps-enrolled children at the Healthy Steps for Young Children site but were significantly different between the Healthy Steps and the non-Healthy Steps for Young Children sites; the effect was driven wholly by differences in psychosocial diagnoses.

Multiple indices that measure health service outcomes suggest benefits of incorporating Healthy Steps for Young Children into pediatric residency training. Most important, continuity of care in residents' practices significantly improved, as did the residents' documentation of psychosocial issues in children.