for this is the use of standardized parent questionnaires that are shown to be more sensitive with DD detection than pediatrician clinical judgment alone. 4 What may explain pediatricians’ lowbuy-inwith formal tools is the nominal training received on child development and psychology, early education, and the systemof services for childrenwith special healthcare needs (CSHCN). 5 Hypo- thetically, if a patient is identified with a delay, the chasm in knowledge on how to link families to community-based services may appear daunting to the provider, thus affecting the family’s efficacy to navigate the service system. In an effort to address the sparse training, Bauer et al. conducted a pediatric resident education intervention to improve screening knowledge and referral self-efficacy to increase PDS rates. 6 The intervention improved rates by roughly 90% and also found a greater increase in PDS knowledge for first-year residents versus third-year residents, despite similar baseline knowledge. 6 The medical home (MH) defines the pivotal role of the pediatrician in the provision of culturally competent, compassionate, coordinated, and comprehensive primary care and is a model that has been shown to reduce dispari- ties for access and need. 7 Romaire and Bell used medical expenditure panel survey data and found that children (<17 years) with anMH had greater odds for general health screening and anticipatory guidance on healthy behaviors. 8 In 2007, the AAP recommended that for early intervention
services the “pediatric healthcare professional is the most appropriate healthcare consultant, coordinator, and source of referral” (and) “regardless of the pediatric healthcare setting, this care can be provided in accordance with the precepts of theMH.” 9 Moreover, the role of theMHprovider with regards to early intervention is to first conduct a PDS. 9 It is with this background in mind that we aim to answer the following: what is the association between the MH and PDS among US children five years and younger? METHODS The 2007 national survey of children’s health (NSCH) is a cross-sectional, complex, randomly sampled survey that provides both national and state estimates on the prevalence of child health indicators and service system use. 10 Survey respondents are the primary guardian of a ran- domly selected child from a randomly selected household. Households are contacted through random digit dialing methodology. The 2007 NSCH was conducted between April 2008 and July 2008, encompassed 91,642 interviews, and resulted in an overall weighted response rate of 46.7%. 10 Sampling weights reflect the total US child population. A more comprehensive description of the surveymethodology is detailed elsewhere. 10 Because children <10 months or >5 years at the time of the survey were not assessed for PDS, our study is limited to those between these ages ( n =27,566).
J La State Med Soc VOL 166 May/June 2014 111
Made with FlippingBook - Online catalogs