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Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. e37-e43 (doi:10.1542/peds.2008-3385)
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ARTICLE

The Use of Internet-Based Technology to Tailor Well-Child Care Encounters

David Aaron Bergman, MDa, Arne Beck, PhDb, Alanna Kulchak Rahm, MSb

a Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
b Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado

OBJECTIVE: The goal was to evaluate the feasibility and acceptance of a new model for well-child care (WCC) in a large health maintenance organization.

METHODS: We designed a new model of WCC that engages families in Internet-based developmental and behavioral screening, allows for review of the results before the visit, and allows for selection of the appropriate visit type (e-visit, e-visit with brief provider visit, or extended encounter). The new model was pilot-tested in 2 practices within a large health maintenance organization. Seven providers and 70 parents participated in the study. Parents and providers were surveyed regarding their experience and satisfaction with the encounter.

RESULTS: Seventy-five percent of parents thought that the online previsit assessment improved or very much improved the WCC visit. However, 12% of parents found the online assessment somewhat or very difficult to use. All of the parents found the e-visit or the e-visit with brief provider visit acceptable or very acceptable, compared with a standard WCC visit. All 7 providers thought that use of the new model helped focus the visit and that they would continue or definitely continue to use the model.

CONCLUSIONS: We demonstrated the feasibility of a new model of WCC that engaged parents in previsit assessment and used alternative visit types to tailor care to the needs of the family. Future research will be needed to examine the impact of this model on important WCC outcomes.

Key Words: preventive services • child health services • systems analysis

Abbreviations: WCC—well-child care • CSHCN—children with special health care needs • HMO—health maintenance organization • CHADIS—Child Health and Development Interactive System

Accepted Feb 24, 2009.


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