1. Home>
2. Specialties>
3. Pediatrics and Adolescent Medicine>
4. Summary and Comment

Modifying Well-Child Visits Based on Biopsychosocial Risk

An Internet-based screening tool helped physicians tailor well-child care.

Limited time and resources are barriers to screening, counseling, and monitoring children for developmental and behavioral conditions during well-child visits. Researchers conducted a pilot study with seven pediatricians and 78 parents from a large HMO to evaluate the feasibility and acceptance of a new model of well-child care.

Under the new model, parents completed a 20-minute, Internet-based developmental and behavioral screening survey about 2 weeks before the scheduled well-child visit. Children with normal screening tests had a fully electronic visit instead of a traditional office visit; any parental concerns were addressed by e-mail exchange. Children with normal screening tests who needed immunizations or growth measurements or who had other health issues received an e-visit and a brief office visit, including a physical exam. Children with chronic or extenuating problems received an extended office visit; a developmental specialist or chronic care coordinator might have been included in the visit.

In a telephone survey, more than 80% of parents who had e-visits alone or a brief office visit reported that they were satisfied or very satisfied with the encounter and that the online previsit screening was more efficient than traditional well-child visits. Parents who had extended visits for children with special healthcare needs reported that the office visits were more efficient, identified problems more effectively, and improved care coordination compared with traditional office visits. However, 12% of all parents thought the previsit assessment was difficult. All participating clinicians reported that the new model helped focus the well-child visit and that they would continue using the new model.

Comment: This model is an example of the potential for innovation to improve well-child healthcare practices. Limitations of the study include lack of a control group, an HMO setting unchallenged by fee-for-service reimbursement, and a population with high computer literacy. The authors are conducting a larger controlled study that includes low-income families. Even without an Internet screening tool, pediatricians might think about new ways to tailor well-child visits based on psychosocial and developmental risk.

— Martin T. Stein, MD

Published in Journal Watch Pediatrics and Adolescent Medicine August 5, 2009

Citation(s):

Bergman DA et al. The use of internet-based technology to tailor well-child care encounters. Pediatrics 2009 Jul; 124:e37.

• Original article (Subscription may be required)
• Medline abstract (Free)