Well Visit Planner

Vision of the Well Visit Planner

 

The Well Visit Planner (WVP) was developed to fill the gaps in the quality of well-child care that are persistent and documented, including engaging parents as partners in improving their child’s health care, highlighting parent priorities for visits, alleviating the burden on providers, and fostering trusting relationships between providers and patients.

Development and Testing of the Well Visit Planner

 

  • The WVP was developed and tested for use in pediatric practices under a four-year grant from the U.S Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Research Program between 2008 and 2012 (R40 MC08959 03-00; 2008-2012). National experts, families and pediatric providers all collaborated in the design, development and testing of the WVP tools to ensure feasibility and to optimize impact on the quality and efficiency of the well-child visit for parents, children and provider teams alike.
  • The WVP was initially tested and implemented at a clinic with 12 pediatricians located in Tualatin, This clinic implemented a customized version of the WVP with a unique URL and Electronic Health Record (EHR) integration (Centricity). Their EHR-linkage included several specific fields that were auto-populated with WVP responses and a PDF of the visit guide sent directly to the child’s EHR. In addition to posting informational posters about the WVP in exam and waiting rooms and providing a link on their website, eligible parents were invited via email to complete the WVP 5 days prior to their child’s well visit. Focus groups were also conducted in Oregon Head Start Centers to establish the utility of the WVP in Head Start/Early Head Start Centers.
    Read this report to learn more about the initial testing of the WVP. Patient Centered Quality Improvement of Well-Child Care.
  • The WVP was also used in a study at the University of California, Los Angeles (UCLA), in collaboration with community clinics, including Federally Qualified Health Centers (FQHCs). In addition to parents receiving their personalized visit guide, UCLA developed an EHR-integrated WVP option in which only major concerns and alerts from the parental responses on the WVP were linked into the child’s EHR.
    Read this article for a full description: Coker, T. R., Chacon, S., Elliott, M. N., Bruno, Y., Chavis, T., Biely, C., Chung, P. J. (2016). A Parent Coach Model for Well-Child Care Among Low-Income Children: A Randomized Controlled Trial.
  • The WVP was piloted in the Boston Children’s pediatric primary care network (PPOC), during which the parent visit guide was integrated into the child’s EMR using secure e-faxing methods.
  • In Fall 2013, the WVP was expanded to include the 4-, 5- and 6-year well-child visits. This and consideration of the application of the WVP for Head Start/Early Head Start Centers programs was supported through a subcontract from the AAP through its cooperative agreement for the Head Start National Center on Healthwith the Administration for Children and Families (ACF). Implementation toolkits were vetted with focus groups with Head Start program staff.
  • The CAHMI also partnered with the Help Me Grow National Center to utilize the WVP to provide support for HMG affiliate sites to engage families, communities, and child health providers in promoting children’s healthy development.
  • The WVP has also been implemented in western Mexico with a group of low-income families in 3 communities, who used the tool to learn about child development and identify their needs for group visits.
  • The WVP parent tool has been made publicly available and is continued to be used by families, providers, practices, as well as community organizations, which CAHMI does not track in an active manner. We look forward to furthering the use of the WVP, partnering with new users to continuously learn and improve this tool and expanding the suite of options by potentially adapting the WVP model to other age groups and health care topics for children.

Family Response to Well Visit Planner Testing

 

  • Of the 3000 parents included in the Oregon testing, 92% reported that they would recommend the tool to other parents and that they were comfortable with the time required to complete the tool, 82% said the WVP helped them understand goals for each well visit, and 86% said the WVP helped prioritize topics for discussion with their child’s pediatric healthcare professional. The Children’s clinic in Oregon also used a pre/post measure, the online/web-based Promoting Health Development Survey (PHDS), in conjunction with the WVP to assess quality and content of well-child care provided with and without use of the WVP. This clinic was involved in the original research grant to develop the WVP and they continue to use the tool now that the grant has ended.
  • Of the UCLA study participants, 97% reported that it was helpful or very helpful in preparing for their well-visit, 94% it was easy or very easy to use and 96% would recommend that it continue to be available for well-visits.
  • Testing of the WVP with parents in Mexico showed that parents gained knowledge that they could share with other doctors and this built their sense of being a partner.

Provider Response to Well Visit Planner Testing

 

  • Overall, providers and staff who have used the WVP in Oregon have noted that it improved their office workflow and they valued it as an important tool to support well-child care in their practice. Providers and staff noted that use of the tool: (1) freed up nurses’ time to address new issues and topics; (2) helped providers to prepare for the visit before they met with the parent; (3) allowed nursing staff to print materials targeted to parents needs before the visit; and (4) helped to prevent delays in the appointment time. Although both the providers and staff acknowledged that they faced some initial hurdles in the process of implementing the WVP (e.g. use of the reminder system and new EHR forms), they agreed that once implemented, the tool was an improvement in their office process.
  • Providers found the tool to be particularly valuable with regard to supporting assessment of the family environment and efforts to target anticipatory guidance and parent education to the family’s needs. They noted that after implementing the tool they felt better informed about their patient’s home-lives and suggested that the opportunity for parents to provide this information via the online tool may help facilitate provider-parent conversations that are sometimes awkward or uncomfortable. Some providers also reported that parents had begun asking more questions about behavior and development since they implemented the tool, and others indicated an increased focus on dental care.
  • The WVP tool was found to be acceptable and feasible to implement for providers, staff and parents. The UCLA study also demonstrated that 52% fewer intervention children had 2 or more emergency department visits over the 12-month period. Once the implementation hurdles were overcome, the use of the tool became embedded in the practice’s office system and culture, and providers and staff reported improvements in their office workflow.