Use of Internet-Based Technology to Tailor Well-Child Care Encounters

Background: Well-child care (WCC) visits represent the primary way in which children in the health care system receive developmental and preventive care services. Current WCC is not meeting the needs of families. Pediatricians want to do better but are constrained by lack of time and resources. Internet technology offers the opportunity to engage parents in WCC and to extend the encounter. METHODS: We designed a new model of WCC that engages families in Internet-based developmental and behavioral screening, allows for review of the results before the visit, and allows for selection of the appropriate visit type (e-visit, e-visit with brief provider visit, or extended encounter). The new model was pilot-tested in 2 practices within a large health maintenance organization. Seven providers and 70 parents participated in the study. Provider and parent telephone surveys were conducted to assess the feasibility and acceptance of the new model. We also collected data on visit times for each visit type, provider time for review of the previsit assessment, and preparation for the visit. Finally, we collected data on how the high-performing system of WCC compared with usual WCC. The site for our project was Kaiser Permanente Colorado, a group model health maintenance organization (HMO) serving 100,000 children in the Denver, Colorado, metropolitan area. RESULTS: Seventy-five percent of parents thought that the online previsit assessment improved or very much improved the WCC visit. However, 12% of parents found the online assessment somewhat or very difficult to use. All of the parents found the e-visit or the e-visit with brief provider visit acceptable or very acceptable, compared with a standard WCC visit. All 7 providers thought that use of the new model helped focus the visit and that they would continue or definitely continue to use the model. CONCLUSIONS: We have developed a new model for WCC that builds on previous research in the field and involves Internet-based technologies. We have shown that it is possible to implement the model in an HMO setting that demonstrated positive effects on provider and family experiences. Future research is needed to assess the impact on preventive and developmental service outcomes for children and to better understand the changes and modifications of the model that will be required for use in different settings and diverse patient populations