The Association Between the Medical Home and Pediatric Developmental Screening Among US Children Five Years and Younger: Results From the 2007 National Survey of Children’s Health
Nicole Richmond, MPH; Tri Tran, MD, MPH; Susan Berry, MD, MPH
Objectives : The medical home is associated with key healthcare services. We assessed its association with the pediatric developmental screening among United States (US) children < five years. Methods : The 2007 national survey of children’s health data was analyzed using state clusters, and pediatric developmental screening probability was modeled as a function of the medical home. Results : Only 19.5% of US children received pediatric developmental screening, and crosstabs showed a null medical home association. Based on medical home status, adjusted state models showed much variation in pediatric developmental screening odds. A random intercept and slope model had the best fit. The medical home increased pediatric developmental screening odds by 24% (1.10, 1.38). Conclusions : The pediatric developmental screening rate and the medical home association are partially in- fluenced by an individual’s state. A multilevel model including state level predictors will help illuminate factors that promote healthcare service acquisition. This knowledge will enhance policy development in public and private sector health programs.
INTRODUCTION The adage “an ounce of prevention is worth a pound of cure” can be interpreted in countless ways given context. In the milieu of infectious disease, public health practitio- ners might focus on timely administration of vaccinations to inoculate a populace, thereby creating herd immunity. In the context of chronic disease such as birth defects, it is not incidence that is prevented but rather an increase in prevalence with the aim to minimize long-term sequelae and corresponding incidence of co-morbidities. In one sce- nario, eradication of onset is the goal, while for the latter, it is reduction of deleterious consequences. However, both capture the same sentiment: early detection and interven- tion will impart a greater impact on population health than treatment alone. A 2006 American Academy of Pediatrics (AAP) policy outlines the pivotal role of the pediatrician to conduct age- specific developmental delay (DD) surveillance as part of the
well-child visit. The rationale illuminates the hidden nature of DD. Symptoms or characteristics are often intertwined with nervous system plasticity, and thus, screening ideally occurs during critical periods of development (9, 18, and 30 months old). 1 This longitudinal evaluation method helps to assess the duration, intensity, and accumulation of child and family risk factors that may have a temporal influence toward imparting phenotypic aberrations in normal devel- opment. As such, the AAP policy highlights the need for pediatric developmental screening (PDS) using standard- ized tools to detect veiled aberrations in development. Research supports PDS use. A study by Voigt and col- leagues found a strong association between DD and parent- ing stress (assessed by parents’ evaluation of developmental status (PEDS)). 2 However, few clinicians implement PDS, as reflective of the slight change in PDS rates: between 2002 and 2009, PDS went from 23% to roughly 48%. 3 Likewise, in 2002, 71% said they relied solely on clinical judgment, and fewer (66%) reported the same in 2009. 3 One likely reason
J La State Med Soc VOL 166 May/June 2014 109
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