Gaps in well-child care attendance among primary care clinics serving low-income families
Open accessAbstract
BACKGROUND AND OBJECTIVES: It is unclear which specific well-child visits (WCVs) are most frequently missed and whether age-specific patterns of attendance differ by race or insurance type. METHODS: We conducted a retrospective cohort study of children 0 to 6 years old between 2011 and 2016 within 2 health networks spanning 20 states. WCVs were identified by using International Classification of Diseases, Ninth and 10th Revisions and Current Procedural Terminology codes. We calculated adherence to the 13 American Academy of Pediatrics–recommended WCVs from birth to age 6 years. To address data completeness, we made 2 adherence calculations after a child’s last recorded WCV: 1 in which we assumed all subsequent WCVs were attended outside the network and 1 in which we assumed none were. RESULTS: We included 152 418 children in our analysis. Most children were either publicly insured (77%) or uninsured (14%). The 2-, 4-, and 6-month visits were the most frequently attended (63% [assuming no outside care after the last recorded WCV] to 90% [assuming outside care]), whereas the 15- and 18-months visits (41%–75%) and 4-year visit (19%–49%) were the least frequently attended. Patients who were publicly insured and uninsured (versus privately insured) had higher odds of missing WCVs. Hispanic and Asian American (versus non-Hispanic white) patients had higher odds of attending WCVs. DISCUSSION: The 15- and 18-month WCVs as well as the 4-year WCV are the least frequently attended WCVs. The former represent opportunities to identify developmental delays, and the latter represents an opportunity to assess school readiness.
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- Authors
- Wolf, E. R., Hochheimer, C. J., Sabo, R. T., DeVoe, J., Wasserman, R., Geissal, E., Opel, D. J., Warren, N., Puro, J., O’Neil, J., Pecsok, J., & Krist, A. H.
- Affiliations
- Virginia Commonwealth University (US)
- Oregon Health & Science University (US)
- University of Vermont (US)
- University of Washington (US)
- Ochin (US)
- Family Medicine and Population Health, and
- ORCID
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2018-11-01
- Volume
- 142
- Issue
- 5
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- PMC
- PMC7063686
- OpenAlex
- W2897505664
- Cited by
- 97
- References
- 32
- Citations by year
- 2026: 9 · 2025: 15 · 2024: 16 · 2023: 11 · 2022: 19 · 2021: 14 · 2020: 9 · 2019: 2 · 2013: 1
- FWCI
- 9.55
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (UL1TR002649)
- Agency for Healthcare Research and Quality (R01HS024270)
- National Cancer Institute (R01CA166375)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Health Professions › General Health Professions › Child and Adolescent Health
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- well-child visits, primary care, low-income households, public insurance, uninsured children, racial disparities, Hispanic children, Asian American children, developmental delay screening, school readiness, American Academy of Pediatrics guidelines
- MeSH terms
- Child, Child Health Services, Child, Preschool, Female, Humans, Infant, Infant, Newborn, Insurance, Health, Male, Patient Compliance, Poverty, Primary Health Care, Retrospective Studies, United States, Cohort Studies, Health Care Surveys
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