Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia.
Departments of Pediatrics and Children's Development and Innovation Institute.
Pediatrics. 2024 Aug 1;154(2). doi: 10.1542/peds.2023-065232.
Early intervention services can improve outcomes for children with developmental delays. Health care providers, however, often struggle to ensure timely referrals and services. We tested the effectiveness of telephone-based early childhood developmental care coordination through 211 LA, a health and human services call center serving Los Angeles County, in increasing referral and enrollment in services.
In partnership with 4 clinic systems, we recruited and randomly assigned children aged 12 to 42 months with upcoming well-child visits and without a known developmental delay, to intervention versus usual care. All children received developmental screening and usual clinic care. Intervention children also received telephone connection to a 211 LA early childhood care coordinator who made referrals and conducted follow-up. Primary outcomes at a 6-month follow-up included parent-reported referral and enrollment in developmental services. Secondary outcomes included referral and enrollment in early care and education (ECE). Logistic regression models were used to estimate the odds of outcomes, adjusted for key covariates.
Of 565 families (282 intervention, 283 control), 512 (90.6%) provided follow-up data. Among all participants, more intervention than control children were referred to (25% vs 16%, adjusted odds ratio [AOR] 2.25, P = .003) and enrolled in (15% vs 9%, AOR 2.35, P = .008) ≥1 service, and more intervention than control children were referred to (58% vs 15%, AOR 9.06, P < .001) and enrolled in (26% vs 10%, AOR 3.75, P < .001) ECE.
Telephone-based care coordination through 211 LA is effective in connecting young children to developmental services and ECE, offering a potentially scalable solution for gaps and disparities.
早期干预服务可以改善发育迟缓儿童的结局。然而，医疗保健提供者在确保及时转诊和服务方面常常面临困难。我们通过洛杉矶的一个健康和人类服务呼叫中心 211 LA 测试了基于电话的幼儿发育保健协调对增加服务转诊和参与的效果。
我们与 4 个诊所系统合作，招募并随机分配即将进行常规儿童健康检查且无已知发育迟缓的 12 至 42 月龄儿童，进入干预组或常规护理组。所有儿童均接受发育筛查和常规诊所护理。干预组儿童还通过电话与 211 LA 幼儿保健协调员联系，协调员进行转诊并开展后续工作。6 个月随访时的主要结局包括家长报告的转诊和发育服务参与情况。次要结局包括早期保健和教育（ECE）的转诊和参与。使用逻辑回归模型估计结局的比值比（OR），并调整了关键协变量。
在 565 个家庭（282 个干预组，283 个对照组）中，有 512 个（90.6%）提供了随访数据。在所有参与者中，与对照组相比，更多的干预组儿童被转诊（25%比 16%，调整后的 OR 2.25，P =.003）并参与（15%比 9%，OR 2.35，P =.008）≥1 项服务，更多的干预组儿童被转诊（58%比 15%，OR 9.06，P <.001）并参与（26%比 10%，OR 3.75，P <.001）ECE。
通过 211 LA 进行基于电话的保健协调可有效将幼儿与发育服务和 ECE 联系起来，为解决差距和不平等问题提供了一种潜在的可扩展解决方案。
