Mooney Kelly, Moreno Candice, Chung Paul J, Elijah Jacinta, Coker Tumaini R
David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
J Prim Care Community Health. 2014 Jan 1;5(1):19-23. doi: 10.1177/2150131913511641. Epub 2013 Dec 5.
Community health centers (CHCs) are a key element of the health care safety net for underserved children. They may be an ideal setting to create well-child care (WCC) clinical practice redesign to drastically improve WCC delivery.
To examine the perspectives of clinical and administrative staff at a large, multisite urban CHC on alternative ways to deliver WCC services for low-income children aged 0 to 3 years.
Eight semistructured interviews were conducted with 4 pediatric teams (each consisting of 1 pediatrician and 2 medical assistants) and 4 CHC executive/administrative staff (Medical Director, COO, CEO, and Nurse Supervisor). Discussions were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis. Salient themes included WCC delivery challenges and endorsed WCC clinical practice redesign solutions.
The 3 main WCC delivery challenges included long wait times due to insurance verification and intake paperwork, lack of time for parent education and sick visits due to WCC visit volume, and absence of a system to encourage physicians to use non-face-to-face communication with parents. To address WCC delivery challenges, CHC providers and administrators endorsed several options for clinical practice redesign in their setting. These included use of a health educator in a team-based model of care, a previsit tool for screening and surveillance, Web site health education, a structured system for non-face-to-face (eg, phone) parent communication, and group visits.
CHC-specific strategies for WCC clinical practice redesign endorsed by a large, multisite safety net clinic may lead to more efficient, effective, and family-centered WCC for low-income populations.
社区卫生中心（CHC）是为服务不足儿童提供医疗安全网的关键要素。它们可能是进行儿童保健（WCC）临床实践重新设计以大幅改善WCC服务提供的理想场所。
探讨一家大型多站点城市社区卫生中心的临床和行政人员对为0至3岁低收入儿童提供WCC服务的替代方式的看法。
对4个儿科团队（每个团队由1名儿科医生和2名医疗助理组成）以及4名社区卫生中心行政/管理人员（医学主任、首席运营官、首席执行官和护士主管）进行了8次半结构化访谈。讨论内容进行了录音、转录，并采用定性分析的持续比较法进行分析。突出的主题包括WCC服务提供面临的挑战以及认可的WCC临床实践重新设计解决方案。
WCC服务提供面临的3个主要挑战包括：由于保险核实和入院文书工作导致等待时间过长；由于WCC就诊量导致缺乏家长教育和处理生病就诊的时间；以及缺乏鼓励医生与家长进行非面对面沟通的系统。为应对WCC服务提供挑战，社区卫生中心的提供者和管理人员认可了在其机构中进行临床实践重新设计的几种选择。这些选择包括在基于团队的护理模式中使用健康教育工作者、用于筛查和监测的就诊前工具、网站健康教育、用于非面对面（如电话）家长沟通的结构化系统以及集体就诊。
一家大型多站点安全网诊所认可的针对社区卫生中心的WCC临床实践重新设计策略，可能会为低收入人群带来更高效、有效且以家庭为中心的WCC服务。
