Assessing the impact of pediatric-based development services on infants, families, and clinicians: challenges to evaluating the Health Steps Program.

摘要: Background. Begun in 1996, the Healthy Steps for Young Children Program (HS) is a new model of pediatric practice that incorporates child development specialists and enhanced developmental services families young children. HS all families, not just those at high-risk. It expected to strengthen parents9 knowledge, attitudes, behaviors ways promote health development, turn, lead improved outcomes, such as language increased utilization well care, decreased problem behaviors, hospitalizations, injuries. The evaluation designed assess whether successful achieving desired measure program9s costs, determine relation costs its outcomes. Objective. This article first report evaluation. describes design characteristics sites sample Methods. following cohort children from birth age 3 15 across country. represent range organizational settings include group practices, hospital-based clinics, maintenance organization clinics. relies on 2 comparison strategies. At 6 randomization sites, 400 were randomized intervention or control group. 9 quasi-experimental location with similar setting patient profile has been selected up 200 are being followed each these sites. site, (or their full-time equivalents) work team 4 8 pediatricians nurse practitioners. specialist conducts office visits (jointly sequentially clinician) home visits, assesses children9s progress, provides referrals follow-up resources community, organizes parent discussion groups, coordinates early reading activities, maintains telephone information line questions about behavior. many data sources including self-administered provider surveys, key informant interviews, forms completed by parents interviews parents, medical record reviews, site program use, an ongoing log family contacts maintained specialist. Analyses this based enrollment national 1997 US live births. χ goodness-of-fit test was used evaluate distribution demographic variables, insurance, infant9s weight distributions births 1997. In addition, comparisons made between independence differences variables groups. Results. Throughout 26-month period, 5565 enrolled evaluation, 2963 (53.2%) 2602 (46.8%) More than 10% mothers teenagers; 18% have 11 years education less; 27% college; black African-American; slightly >20% Hispanic origin; 36% single; close one-third Medicaid prenatal care. Approximately 7% infants low weight. When compared United States whole, seems similarly diverse. However, exception maternal age, significantly different There no any characteristics, insurance status, there number groups more likely be 29 old younger, fewer education, African-American, origin, single. Mothers older They also married, Conclusion. economically ethnically diverse, reflecting diversity nation whole. seem As important, use approach effective equalizing indicate need take account analyzing effects. within-site correlation between-site variability effects HS, between-provider type random models will analyses. These referred hierarchical linear multilevel models. carefully address complexities multiple objectives, components, wide expectations. provide practicing clinicians effectiveness improving care families. policy makers empirical evidence inform debate practices appropriate venue helping development. it potential outcomes satisfaction hospitalizations make valuable intervention.