Well-Child Care Clinical Practice Redesign for Young Children

A Systematic Review of Strategies and Tools

Limited evidence is available on the effectiveness of various formats used in the redesign of clinical practice for well-child care.

During infancy and early childhood (0 to 5 years), children routinely receive well-child care (WCC) services and screenings. These encounters with a clinician (pediatrician, family physician, or nurse practitioner) provide parents with information about their child’s health and development. While traditionally the services are delivered in face-to-face visits, pediatric practices increasingly are interested in redesigning care delivery, including offering some services outside the clinical setting.

These investigators examined the literature to systematically review WCC clinical practice redesigns for changes in the structure of care that may affect services, child health outcomes, and quality of care. They found reports of alternative formats of WCC, including:

  • Group WCC—where four to six families with similarly aged children visit with a provider.
  • Non face-to-face formats—such as a web-based system for parents to access topics for guidance before a provider visit or instead of a visit.
  • Non-clinical locations—such as home visits by a nurse practitioner or at a preschool.
  • Services provided through an interventional program—combining physician visits with home visits, a telephone information line, and monthly parent group sessions.

Most interventions (except for Group WCC) were intended to enhance usual care and some reduced acute care utilization.

The investigators called these “promising tools and strategies” that “may be ready for larger-scale trials. Future directions for research include reporting intervention costs and potential cost savings, and a commonly defined set of child and parent outcomes to help researchers build a capacity for comparative studies across interventions.”