Kuo Alice A, Inkelas Moira, Lotstein Debra S, Samson Kyra M, Schor Edward L, Halfon Neal
Department of Pediatrics, Mattel Children's Hospital at UCLA, Los Angeles, California, USA.
Pediatrics. 2006 Oct;118(4):1692-702. doi: 10.1542/peds.2006-0620.
The increasing scope of health supervision recommendations challenges well-child care delivery in the United States. Comparison of the United States with other countries' delivery systems may highlight different assumptions as well as structural approaches for consideration.
Our goal was to describe the process of well-child care delivery in industrialized nations and compare it to the US model of child health care.
Literature reviews and international experts were used to identify 10 countries with unique features of well-child care delivery for comparison to the United States. Key-informant interviews using a structured protocol were held with child health experts in 10 countries to delineate the structural and practice features of their systems. Site visits produced additional key informant data from 5 countries (The Netherlands, England, Australia, Sweden, and France).
A primary care framework was adapted to analyze structural and practice features of well-child care in the 10 countries. Although well-child care content is similar, there are marked differences in the definitions of well-child care and the scope of practice of primary care professionals and pediatricians specifically who provide this care across the 10 countries. In contrast to the United States, none of the countries place all well-child care components under the responsibility of a single primary care provider. Well-child care services and care for acute, chronic, and behavioral/developmental problems are often provided by different clinicians and within different service systems.
Despite some similarities, well-child care models from other countries differ from the United States in key structural features on the basis of broad financing differences as well as specific visions for effective well-child care services. Features of these models can inform child health policy makers and providers in rethinking how desired improvements in US well-child care delivery might be sought.
健康监督建议范围的不断扩大对美国的儿童健康保健服务提出了挑战。将美国与其他国家的服务体系进行比较，可能会凸显出不同的假设以及可供考虑的结构性方法。
我们的目标是描述工业化国家儿童健康保健服务的提供过程，并将其与美国的儿童保健模式进行比较。
通过文献综述和国际专家，确定了10个具有独特儿童健康保健服务特点的国家，以便与美国进行比较。使用结构化协议对这10个国家的儿童健康专家进行关键信息访谈，以勾勒其体系的结构和实践特点。实地考察从5个国家（荷兰、英国、澳大利亚、瑞典和法国）获取了更多关键信息数据。
采用初级保健框架来分析这10个国家儿童健康保健服务的结构和实践特点。尽管儿童健康保健内容相似，但在这10个国家中，儿童健康保健的定义以及提供此项服务的初级保健专业人员和儿科医生的实践范围存在显著差异。与美国不同，没有一个国家将所有儿童健康保健内容都置于单一初级保健提供者的责任之下。儿童健康保健服务以及急性、慢性和行为/发育问题的护理通常由不同的临床医生在不同的服务体系中提供。
尽管存在一些相似之处，但由于广泛的资金差异以及对有效儿童健康保健服务的具体设想，其他国家的儿童健康保健模式在关键结构特征上与美国不同。这些模式的特点可以为儿童健康政策制定者和提供者在重新思考如何寻求美国儿童健康保健服务的理想改进方面提供参考。
