Abstract
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.
Keywords
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Article Info
Publication History
Published online: August 26, 2021
Accepted:
August 21,
2021
Received:
March 25,
2021
Footnotes
The authors have no conflicts of interest to disclose.
Identification
Copyright
Copyright © 2021 by Academic Pediatric Association
