Objective

Primary care centers are trialing open access scheduling models to expand access. Given evidence linking irregular caregiver work schedules with adverse child developmental outcomes, we hypothesized that children presenting for unscheduled “walk-in” visits would have higher odds of developmental concerns than those presenting for scheduled visits.

Methods

We conducted a retrospective review of electronic health record data for children aged 6 to 66 months visiting an academic pediatric primary care center between July 1, 2013 and February 1, 2019. Our primary outcome was presence of developmental concerns, defined by results below cutoff on a child's Ages & Stages Questionnaire, Third Edition (ASQ-3). We examined associations between visit stream (unscheduled vs scheduled; time of day) and ASQ-3 using multivariable logistic regression, adjusting for child demographics, visit type (well-child vs ill), and responses to a standardized social history questionnaire.

Results

Of 11,169 eligible total encounters each for a unique child, 8% were unscheduled (n = 848); 19% had developmental concerns in at least one domain (n = 2100). Twenty-eight percent of children presenting for unscheduled visits had developmental concerns compared to 18% of those presenting for scheduled visits (P < .0001). Compared to those presenting for scheduled well-child visits, children presenting for unscheduled ill visits had a higher odds of an ASQ-3 score below cutoff (adjusted odds ratio 2.02; 95% confidence interval, 1.54–2.65).

Conclusions

As pediatric primary care centers implement open access scheduling models, they should be prepared to identify and respond to developmental concerns at a rate that may be higher than what is typically seen during scheduled visits.

中文翻译：

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计划外的儿科初级保健就诊与发育迟缓风险之间的关联

客观的

初级保健中心正在试验开放访问调度模型以扩大访问范围。鉴于有证据表明不规则的看护者工作时间表与儿童发育不良结果有关，我们假设进行计划外“步入式”就诊的儿童比计划就诊的儿童更容易出现发育问题。

方法

我们对 2013 年 7 月 1 日至 2019 年 2 月 1 日期间访问学术儿科初级保健中心的 6 至 66 个月儿童的电子健康记录数据进行了回顾性审查。我们的主要结果是存在发育问题，定义为低于截止日期的结果儿童年龄和阶段问卷，第三版 (ASQ-3)。我们使用多变量逻辑回归检查了访问流（计划外与计划；一天中的时间）和 ASQ-3 之间的关联，调整了儿童人口统计数据、访问类型（健康儿童与生病）以及对标准化社会历史问卷的回答。

结果

在 11,169 次符合条件的总遭遇中，每一次遇到一个独特的孩子，8% 是计划外的（n = 848）；19% 的人在至少一个领域存在发展问题（n = 2100）。28% 的非计划就诊儿童有发育问题，而计划就诊的儿童中这一比例为 18% ( P < .0001)。与那些参加计划好的儿童就诊的儿童相比，计划外就诊的儿童的 ASQ-3 评分低于临界值的几率更高（调整后的优势比 2.02；95% 置信区间，1.54-2.65）。

结论

随着儿科初级保健中心实施开放访问调度模型，他们应该准备好以可能高于通常在计划访问期间看到的速度来识别和响应发育问题。