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Parent-reported quality of preventive care for children at-risk for developmental delay
Tumaini R Coker1, Yahya Shaikh, Paul J Chung
1Department of Pediatrics, David Geffen School of Medicine and Mattel Children's Hospital at UCLA, Los Angeles, CA 90024, USA. tcoker@mednet.ucla.edu
Insights
Children at risk for developmental delays receive lower quality preventive care, including less care coordination and family-centered support. Enhanced screening and communication are needed to meet the needs of these at-risk children.
Area of Science:
- Pediatric Health
- Preventive Care Quality
- Developmental Pediatrics
Background:
- Children at risk for developmental, behavioral, or social delays require specialized preventive care.
- Assessing the quality of care for these children is crucial for early intervention and improved outcomes.
Purpose of the Study:
- To compare the quality of preventive care received by children at risk for developmental delays versus those not at risk.
- To identify specific areas where care quality may be deficient for at-risk children.
Main Methods:
- Utilized data from the 2007 National Survey of Children's Health (n=22,269).
- Employed the Parents' Evaluation of Developmental Status (PEDS) questionnaire to identify at-risk children (10 months to 5 years).
- Examined parent-reported measures of care comprehensiveness, coordination, family-centeredness, developmental screening, and medical home quality using bivariate and multivariate analyses.
Main Results:
- Twenty-eight percent of children were identified as at-risk for delays (17% moderate, 11% high risk).
- While most children had a usual source of care and a personal doctor/nurse, standardized developmental screening and elicitation of parental concerns were low across all risk groups.
- In adjusted analyses, children at moderate and high risk were significantly less likely to receive care coordination, referrals, family-centered care, and to have a medical home compared to no/low-risk children.
Conclusions:
- Findings suggest potential disparities in preventive care quality for children at risk for developmental delays.
- Routine visits may not adequately address the needs of at-risk children.
- Enhanced screening, detection, communication, and follow-up are recommended to better meet the needs of at-risk children and their families.
Objective:
To compare preventive care quality for children at risk and not at risk for developmental, behavioral, or social delays.
Methods:
Using the 2007 National Survey of Children's Health (n = 22,269), we used the Parents' Evaluation of Developmental Status (PEDS) questionnaire to identify children ages 10 months to 5 years who were at risk for delays. We examined parent-reported quality measures to evaluate whether care was comprehensive, coordinated, family-centered, effective in providing developmental surveillance and screening, and provided within a medical home. Bivariate and multivariate analyses were used.
Results:
Twenty-eight percent of children were at-risk for delay, with 17% at moderate risk and 11% at high risk. Greater proportions of children at high, moderate, and no/low risk had a usual source of care (89%-96%) and a personal doctor/nurse (91%-94%); smaller proportions of children underwent a standardized developmental screening (16%-23%) and had parental developmental concerns elicited from their doctor (47%-48%). In adjusted analyses, moderate-risk and high-risk children were less likely than no/low-risk children to receive needed care coordination (adjusted odds ratio [AOR] for high risk 0.33, 95% confidence interval [95% CI] 0.24-0.46) and referrals (high risk AOR 0.40, 95% CI 0.25-0.65), family-centered care (high-risk AOR 0.47, 95% CI 0.36-0.62), and to have a medical home (high-risk AOR 0.41, 95% CI 0.32-0.54).
Conclusions:
Our findings may reflect either poorer quality of care provided to at-risk children, or higher level of parental need that routine visits are not currently meeting. For at-risk children, enhanced screening and detection followed by targeted increases in communication and follow-up may help clinicians better anticipate families' needs.
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