232020 Use of Internet-Based Technology to Tailor Well-Child Care Encounters

Wednesday, November 10, 2010 : 8:50 AM - 9:05 AM

Alanna Kulchak Rahm, MS , Institute for Health Research, Kaiser Permanente, Denver, CO
Sharla Fellers, Child Development Specialist , Pediatrics, Kaiser Permanente Colorado, Westminster, CO
Arne Beck, PhD , Kaiser Permanente Colorado, Institute for Health Research, Denver, CO
David Bergman, MD , Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA
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

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs

Learning Objectives:
1. Discuss the components of 21st Century well child care.

Keywords: Pediatrics, Quality Improvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am project manager for the well child program
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.