Parent-Reported Quality of Preventive Care for Children At-Risk for Developmental Delay

ObjectiveTo compare preventive care quality for children at risk and not at risk for developmental, behavioral, or social delays.MethodsUsing the 2007 National Survey of Children’s Health (n = 22,269), we used the Parents’ Evaluation of Developmental Status (PEDS) questionnaire to identify children ages 10 months to 5 years who were at risk for delays. We examined parent-reported quality measures to evaluate whether care was comprehensive, coordinated, family-centered, effective in providing developmental surveillance and screening, and provided within a medical home. Bivariate and multivariate analyses were used.ResultsTwenty-eight percent of children were at-risk for delay, with 17% at moderate risk and 11% at high risk. Greater proportions of children at high, moderate, and no/low risk had a usual source of care (89%–96%) and a personal doctor/nurse (91%–94%); smaller proportions of children underwent a standardized developmental screening (16%–23%) and had parental developmental concerns elicited from their doctor (47%–48%). In adjusted analyses, moderate-risk and high-risk children were less likely than no/low-risk children to receive needed care coordination (adjusted odds ratio [AOR] for high risk 0.33, 95% confidence interval [95% CI] 0.24–0.46) and referrals (high risk AOR 0.40, 95% CI 0.25–0.65), family-centered care (high-risk AOR 0.47, 95% CI 0.36–0.62), and to have a medical home (high-risk AOR 0.41, 95% CI 0.32–0.54).ConclusionsOur findings may reflect either poorer quality of care provided to at-risk children, or higher level of parental need that routine visits are not currently meeting. For at-risk children, enhanced screening and detection followed by targeted increases in communication and follow-up may help clinicians better anticipate families’ needs.