Improving Child Health and Equity With Health System Strengthening: Case Review of UK CHILDS

Child health and equity can be improved through health system strengthening. This case study describes the Children and Young People's Health Partnership's codesigned Child Health Integrated Learning and Delivery System model of care. Innovative services are delivered by Local Child Health teams and include integrated biopsychosocial care, prevention, and early intervention targeted for unmet needs-major transformations in pediatric care. Health system strengthening includes shared governance, integrated financing, and shared data and health records, technology, and workforce training. A Learning Health System facilitates data use for personalized care, continuous service improvement, population health management, and research. Pragmatic cluster randomized controlled trial and service evaluation results are presented with novel analyses of prospective clinical service data assessing access to care. Among 10 615 children triaged, 65.8% were managed with advice and guidance only, 14% were referred for specialist pediatrics, 13.6% were seen in local clinics, and 4.4% had early-intervention biopsychosocial care. Multivariable analysis showed that children from the most economically deprived quintile were 40% more likely to be referred for further care (odds ratio [OR], 1.40; 95% CI, 1.17-1.68) and 90% more likely to require specialist referral (OR, 1.90; 95% CI, 1.47-2.46). This finding suggests that our model is improving equity of reach. However, we have not yet reached our goal of proportionate universalism because children from the most deprived areas have more need than their more affluent peers. Scaled up, strengthened health systems for proportionate universal health care, targeted prevention, and early intervention for children with unmet needs could transform the 20th century sickness care model into a 21st century health-promoting model.