A novel triage approach of child preventive health assessment: an observational study of routine registry-data

The coverage of preventive health assessments for children is pivotal to the system of preventive health screening. A novel method of triage was introduced in the Preventive Youth Health Care (PYHC) system in the Netherlands with an associated shift of tasks of professionals. Doctor's assistants carried out pre-assessments to identify children in need of follow-up assessment, whereas in the traditional approach all children would have been screened by a doctor or nurse. The accessibility and care delivery of this new PYHC system was studied.

The new triage approach was compared to the traditional approach in 780 children undergoing PYHC assessment with the use of an observational retrospective study design. Outcomes were attendance of assessment appointments (accessibility of care) and referral of children to either extra PYHC assessment or external specialised care (delivery of preventive care). PYHC registry data were analysed. In two regions of the Netherlands, 390 children five to six years of age were randomly selected from the PYHC registries according to the socio-economic strata of the schools they attended.

When the triage and traditional approaches to PYHC were compared, we found similar attendance rates for assessment appointments, namely about 90%. As expected, 100% of the children in the traditional group were assessed by a PYHC doctor compared to 46% of the children in the triage group. Significantly fewer children were referred for extra PYHC assessment or for treatment by an external specialised care giver when a triage as opposed to the traditional assessment approach was used (19.6% vs. 45.9%).

The novel triage approach for preventive health assessment shows equal accessibility, but a different delivery of preventive care. A beneficial effect of the adoption of the triage approach is the opportunity to provide more attention from doctors and nurses to children at risk of health problems. However, lower referral rates of the triage approach may be explained by an under-identification of children with health problems. Further research is needed to document the health outcomes and the possible reduction of health care costs with a triage approach compared to traditional PYHC care.