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The study, called "Tailoring Pediatric Preventive Care to Individual Needs, Phase 2: Validating a New Instrument" will be a part of the Fund's program on Child Development and Preventive Care. Researchers at Children's Hospital will test whether a series of questions helps pediatricians identify children at risk for developmental delays. The researchers plan to use their results to help design service packages to meet the specific needs of children at different risk levels.
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"Those children with more challenging problems could benefit from more frequent visits to their doctor, but we don't yet know how to identify those children," said project director Susmita Pati, M.D., M.P.H. "Right now it is a one-size-fits-all approach to pediatric primary care and there is no program for differential insurance reimbursement."
This study may help families with greater needs gain access to more frequent and longer visits with their pediatrician, more help on parenting, frequent interaction with the support staff, and home visits by a nurse or case worker, Pati said.
An earlier Commonwealth Fund project entitled "Tiered Health Supervision," developed the brief set of about a dozen questions to allow doctors to obtain information on individual children and prescribe targeted preventive services. With this second grant, Children's Hospital researchers plan to test the effectiveness of that questionnaire for 2,100 children up to age three. The resulting risk scores will be compared against results of developmental screening and health care utilization data collected by a separate Centers for Disease Control study.
Other Children's Hospital researchers in the project include co-investigators Christopher Forrest, M.D., Ph.D., and James Guevara, M.D., M.P.H; and statistician Russell Localio, Ph.D. Forrest helped develop the questionnaire, which includes predictors such as sociodemographics, birth weight, family environment, child care and receipt of health care.
"The importance of this study is very practical: We know early school failure is related to developmental delays," Pati explains. "We picked out 10 to 15 items that will have reasonable predictive accuracy to how children perform in school by age seven. We want to identify those children who can benefit from more services as early as possible."
Dr. Pati currently is a pediatrician and health services researcher who examines the impact of policy on health care access for underserved children and families. She is an attending general pediatrician at Children's Hospital and Senior Fellow with the Leonard Davis Institute of Health Economics and Associate Scholar at the Center for Clinical Epidemiology and Biostatistics at the University of Pennsylvania. Her prior work focused on the impact of welfare reform on underserved populations and trends in public spending on social welfare programs. Presently, she is funded by the National Institute of Child Health and Human Development to identify predictors of Medicaid retention among underserved children and families and to examine the impact of maternal health literacy on participation in child social welfare programs.
The Commonwealth Fund, among the first private foundations started by a woman philanthropist -- Anna M. Harkness -- was established in 1918 with the broad charge to enhance the common good. The mission of The Commonwealth Fund is to promote a high performing health care system that achieves better access, improved quality, and greater efficiency, particularly for society's most vulnerable, including low-
