First national survey measures parents' opinions on the quality and content of well-child visits

06/02/04

Study shows quality of childhood health care good, but finds parents express more need for key child development issues

In the first nationwide study of its kind, the American Academy of Pediatrics (AAP) and the UCLA Center for Healthier Children, Families & Communities released detailed results of the National Survey of Early Childhood Health (NSECH) today. The survey of a nationally representative sample of more than 2,000 parents of infants and toddlers aged 4 months to nearly 3 years old finds that while many parents are generally satisfied with the quality and content of care provided by physicians caring for young children during well visits, critical areas of health care and development are not being addressed for some children. Among the findings:

  • The vast majority of parents - 86 percent - believe well-child check ups are very important for their child's health and development.

  • A large number - 88 percent - report adequate time with their provider during the last well-child visit, and 79 percent would recommend their child's current physician to others.

  • Parent satisfaction ratings are strongly related to the content and quality of the care they receive - with parental satisfaction ratings increasing when doctors take more time, provide more in-depth discussions about more topics, and provide more family centered care.

  • While many parents report having a regular place to receive preventive care, only about half report having a continuous relationship with a provider and receiving care from the same physician at each well-child visit.

  • Only 57 percent of parents report their child ever having received a developmental assessment screening procedure to detect disabilities that could compromise learning, social interactions and other important functions.

  • Most parents are asked by their provider about smoking in the household. In contrast, fewer than half of parents report receiving advice on family or community issues that may affect early childhood health, such as alcohol use and parent well-being.

  • While 52 percent of parents report reading to their young children on a daily basis as is recommended, the majority of parents who don't read to their children daily 48 percent of all parents of young children would find it useful for pediatricians to discuss the importance of reading.

  • In a special analysis on the discipline strategies and punishment techniques that parents routinely employ with their young children, it was found that parental frustration and low emotional well-being are associated with the use of adverse discipline practices such as spanking and yelling.

    "This study comes at a time when our nation is wrestling with the value of healthcare, the importance of high quality care, and the very important role that healthy development in the early years plays in life-long health, education and productivity," said Neal Halfon, MD, MPH, FAAP, professor of pediatrics, public health and public policy at UCLA, director of the UCLA Center for Healthier Children, Families & Communities, and co-author of the overall study. "There is good news in this study, but there are also a number of findings that confirm and corroborate other smaller and more localized studies that suggest the quality of early childhood health care is not what it should be and needs to be."

    The survey findings, released by the American Academy of Pediatrics (AAP) in a supplement appearing in the June issue of Pediatrics, were designed to collect reliable information from parents regarding priorities in preventive care for young children. The findings are presented as 10 related research papers authored by the same multidisciplinary and multi-institutional team that collaborated on the design and analysis of the survey. This team consists of researchers from UCLA, the AAP, the Child and Adolescent Health Measurement Initiative (CAHMI), the Maternal and Child Health Bureau (MCHB) of the Health Resources and Services Administration, and the Centers for Disease Control and Prevention (CDC). The survey was carried out by the CDC's National Center for Health Statistics. The research was conducted with support from The Gerber Foundation and the analysis was supported by The Commonwealth Fund.

    "Given the importance of preventive care for the health and development of infants and toddlers and the predominant role of pediatricians in their well-child care, we wanted to create a new national data set about the content and quality of the preventive care that children are receiving. Accurate data from parents is key to understanding what families need and the parenting practices that can affect healthy development," remarked Lynn Olson, PhD, co-director of Practice and Research for the AAP. "Pediatricians are interested in providing the best possible care and making sure that they are being responsive to parents' needs and making a difference in children's lives."

    The survey reveals important new information about how recent changes in the health care market place may be affecting how health care is practiced. "One of the hallmarks of good quality primary care is a continuous relationship with a provider. This is especially important when the health care provider is tasked with assessing the often subtle changes in a child's development or delving into sensitive issues about how a young family is coping with parenthood," said Moira Inkelas, PhD, assistant professor of health services at UCLA. "What we found was that, while almost all families report a regular place for well-child care, less than half report a regular person providing that care."

    "With many states now launching early childhood initiatives like California's First 5 and North Carolina's Smart Start, the data included in this study and provided by the National Survey of Early Childhood Health will be immensely useful for local and state planning and program development efforts," stated Ed Schor, MD, FAAP and assistant vice president of The Commonwealth Fund of New York. "The Commonwealth Fund has made a major commitment to improving the quality and availability of developmental and preventive services for young children, and we hope to see the NSECH survey repeated and expanded so that states can continue to get the information they need to launch local quality and systems improvement efforts."

    "This is the first national survey to examine the association between the quality of health and developmental care received and what parents report they are actually doing for their children," stated Michael Kogan, PhD, a co-author of the study. "As the Maternal and Child Health Bureau works with our state MCH colleagues to launch a State Early Childhood Comprehensive Systems Initiative, this survey will provide important information to all state health departments about missed opportunities to receive care, as well as what kind of information and services parents report they need."

    The American Academy of Pediatrics partnered with the UCLA Center for Healthier Children, Families & Communities to develop, design and conduct the NSECH. Other collaborators included the Child and Adolescent Health Measurement Initiative (CAHMI) and the Maternal and Child Health Bureau of the Health Resources and Services Administration. The data were collected by the National Center for Health Statistics, Centers for Disease Control and Prevention (CDC), using the State and Local Area Integrated Telephone Survey mechanism. Major funding for the supplement was provided by The Gerber Foundation, with additional support from The Commonwealth Fund; the Health Resources and Services Administration, Maternal and Child Health Bureau; and the American Academy of Pediatrics Friends of Children Fund.

    Source: Eurekalert & others

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