Health care utilization and health status in high-risk children randomized to receive group or individual well child care.

Abstract

OBJECTIVE: To determine if health care utilization and health status among high-risk children is modified by the use of group well child care (GWCC) as compared with traditional one-to-one individual well child care (IWCC). STUDY DESIGN: Randomized controlled trial. PARTICIPANTS: Children less than 4 months old from families with at least one of the following maternal risk factors: poverty, single marital status, age <20 years at delivery, less than a high school education, previous substance abuse, or history of abuse as a child. SETTING: Two urban, university pediatric clinics in Seattle, Washington. INTERVENTIONS: Children were randomized to receive GWCC or IWCC at the time of enrollment. Health supervision visits with two study nurse practitioners were scheduled at 4, 5, 6, 8, 10, 12, and 15 months of age. GWCC study visits consisted of a group discussion of age-appropriate child-rearing issues, along with a physical examination, health screening, and immunizations. Health care utilization among children receiving GWCC and those randomized to IWCC was assessed using the following measures: compliance with study visits, compliance with any age-appropriate health supervision visit, emergency department utilization, and immunization rates (defined as the proportion of children in each group who had received all recommended vaccines by 1 year of age). Provider time for GWCC and IWCC study visits was also recorded. Health status was measured using Stein's Functional Status IIR, completed by the mothers of study patients when their children completed the study at 15 months of age. RESULTS: A total of 106 children received GWCC, whereas 104 were randomized to IWCC. Compliance with scheduled study visits was 47% for GWCC patients and 54% for IWCC recipients; overall compliance with any age-appropriate health supervision visit was 68% and 66%, respectively. Provider time was similar for GWCC and IWCC visits. By the age of 1 year, 67% of GWCC recipients and 73% of those receiving IWCC had received three DTP/DT, three OPV/IPV, three Hib, and three hepatitis B immunizations. A total of 242 emergency department visits were made by study patients during their enrollment in the project; there was no difference in the average number of visits between GWCC or IWCC children. However, children receiving IWCC were more likely to have at least one emergency department visit than GWCC recipients. At the conclusion of the project, health status, as measured by the Functional Status IIR, was similar in GWCC and IWCC patients (mean scores 92.4 +/- 1.4 and 92.5 +/- 1.1, respectively). CONCLUSIONS: Health care utilization and health status was similar in high-risk children whether they received GWCC or IWCC. GWCC is a viable format for health supervision visits in this population.