Helen M. DuPlessis

Providing care for immigrant, homeless, and migrant children.

This policy statement, which replaces the retired statements “Health Care for Children of Immigrant Families” (1997) and “Health Needs of Homeless Children and Families” (1996), is a broader discussion and addresses not only immigrant but also homeless and migrant child populations. It provides pediatricians with the necessary framework for addressing underserved children: those who face substantial barriers that limit access to appropriate health care services. This statement supports a community-based approach to health care delivery to ensure that underserved children have a medical home.

Well-Child Care Practice Redesign for Low-Income Children: The Perspectives of Health Plans, Medical Groups, and State Agencies

OBJECTIVE The aim of this study was to examine the views of key stakeholders in health care payer organizations on the use of practice redesign strategies to improve the delivery of well-child care (WCC) to low-income children aged 0 to 3 years. METHODS We conducted semistructured interviews with 18 key stakeholders (eg, chief medical officers, medical directors) in 11 California health plans and 2 medical group organizations serving low-income children, as well as the 2 state agencies that administer the 2 largest low-income insurance programs for California children. Discussions were recorded, transcribed, and analyzed using the constant comparative method of qualitative analysis. RESULTS Participants reported that nonphysicians were underutilized as WCC providers, and group visits and Internet services were likely a more effective way to provide anticipatory guidance and behavioral/developmental services. Participants described barriers to redesign, including the start-up costs required to implement redesign as well as a lack of financial incentives to support innovation in WCC delivery. Participants suggested solutions to these barriers, including using pay-for-performance programs to reward practices that expanded WCC services, and providing practices with start-up grants to implement pilot redesign projects that would eventually become self-sustaining. State-level barriers included poor Medicaid reimbursement rates and disincentives to innovation created by current Healthcare Effectiveness Data and Information Set measures. CONCLUSIONS All stakeholders will ultimately be needed to support WCC redesign; however, California payers may need to provide logistic, design, and financial support to practices, whereas state agencies may need to reshape the incentives to reward innovation around child preventive health and developmental services.

Looking back at pediatrics to move forward in obstetrics.

Purpose of review This review assesses the current status of obstetrical care; discusses the life course health development (LCHD) model and its implications for reorganizing systems of care for women of childbearing age; and looks to the child health system for improvement strategies that can be adapted to womens health and obstetric care. Recent findings The LCHD model integrates recent evidence on the developmental origins of health and disease across the life span into a robust framework that can inform a more integrated model of healthcare delivery. We now understand how experiences and exposures early in life influence health trajectories throughout life and can use that knowledge to redesign and retool our health systems, including obstetric care. The authors provide examples of how positive health trajectories are being realized in the child health system through evidence-based programs that prevent risk and promote health. Summary Recently, obstetricians and public health researchers have begun to apply the LCHD model to reconceptualize the development of health trajectories and consider new strategies for improving reproductive outcomes. Recommendations are made for how the LCHD model can be used to reengineer obstetrics and womens healthcare, and offer specific examples of what a system that optimizes womens reproductive readiness would look like.