Parent-reported quality of preventive care for children at-risk for developmental delay

Acad Pediatr. Sep-Oct 2012;12(5):384-90. doi: 10.1016/j.acap.2012.05.003. Epub 2012 Jul 21.

Abstract

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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Case-Control Studies
  • Child Health Services / statistics & numerical data*
  • Child, Preschool
  • Continuity of Patient Care / statistics & numerical data
  • Developmental Disabilities / prevention & control*
  • Female
  • Humans
  • Infant
  • Logistic Models
  • Male
  • Mass Screening / statistics & numerical data
  • Multivariate Analysis
  • Parents
  • Patient-Centered Care / statistics & numerical data
  • Preventive Medicine / statistics & numerical data*
  • Quality of Health Care / statistics & numerical data*