Chuck Norlin, M.D., Morgan A. Crawford, M.D., Christopher T. Bell, Xiaoming Sheng, Ph.D., and Martin T. Stein, M.D.
C. Norlin, M. A. Crawford, C. T. Bell et al., "Delivery of Well-Child Care: A Look Inside the Door," Academic Pediatrics, Jan. 2011 11(1):18–26.
Most evaluations of well-child care rely on clinician or parent surveys or interviews, rather than firsthand observation. In this Commonwealth Fund–supported study, researchers used direct observation of well-child visits to evaluate their duration and content, adherence to Bright Futures guidelines, and differences between visits with children who have special health care needs and visits with children who do not.
Based on observations of 483 visits involving 43 pediatricians and nine mid-level providers, the researchers found that the average visit time was just over 20 minutes. About two-fifths (39%) of visits began with open-ended questions about parents’ concerns, and an average of 7.2 health supervision/anticipatory guidance topics were addressed. On average, clinicians addressed 42 percent of recommended Bright Futures topics; among those often left out were family support, parental well-being, behavior/discipline, and physical activity. Visits with children with special health care needs were 36 percent longer, with more time spent addressing health supervision, testing, prescriptions, and referrals.
The researchers conclude that “much of what is recommended is not accomplished in well-child care visits and that certain recommended health supervision/anticipatory guidance topics are more consistently left unaddressed.” Notably, clinicians who complied with more of the Bright Futures guidelines tended to have shorter visits, suggesting that their use may help achieve efficiency.