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Association Between Unscheduled Pediatric Primary Care Visits and Risk of Developmental Delay

  • Keith J. Martin
    Correspondence
    Address correspondence to Keith Martin, DO, MS, Division of General Pediatrics, Johns Hopkins University School of Medicine, David Rubenstein Child Health Building, 200 North Wolfe Street #2022, Baltimore, MD 21287
    Affiliations
    Department of Pediatrics (KJ Martin), Johns Hopkins University School of Medicine, Baltimore, Md

    Cincinnati Children's Hospital Medical Center (KJ Martin, KA Copeland, Y Xu, D DeBlasio, MC Burkhardt, JF Morehous, and AF Beck), Cincinnati, Ohio
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  • Kristen A. Copeland
    Affiliations
    Cincinnati Children's Hospital Medical Center (KJ Martin, KA Copeland, Y Xu, D DeBlasio, MC Burkhardt, JF Morehous, and AF Beck), Cincinnati, Ohio

    Department of Pediatrics (KA Copeland, D DeBlasio, MC Burkhardt, JF Morehous, and AF Beck), University of Cincinnati College of Medicine, Cincinnati, Ohio
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  • Yingying Xu
    Affiliations
    Cincinnati Children's Hospital Medical Center (KJ Martin, KA Copeland, Y Xu, D DeBlasio, MC Burkhardt, JF Morehous, and AF Beck), Cincinnati, Ohio
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  • Dominick DeBlasio
    Affiliations
    Cincinnati Children's Hospital Medical Center (KJ Martin, KA Copeland, Y Xu, D DeBlasio, MC Burkhardt, JF Morehous, and AF Beck), Cincinnati, Ohio

    Department of Pediatrics (KA Copeland, D DeBlasio, MC Burkhardt, JF Morehous, and AF Beck), University of Cincinnati College of Medicine, Cincinnati, Ohio
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  • Mary Carol Burkhardt
    Affiliations
    Cincinnati Children's Hospital Medical Center (KJ Martin, KA Copeland, Y Xu, D DeBlasio, MC Burkhardt, JF Morehous, and AF Beck), Cincinnati, Ohio

    Department of Pediatrics (KA Copeland, D DeBlasio, MC Burkhardt, JF Morehous, and AF Beck), University of Cincinnati College of Medicine, Cincinnati, Ohio
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  • John F. Morehous
    Affiliations
    Cincinnati Children's Hospital Medical Center (KJ Martin, KA Copeland, Y Xu, D DeBlasio, MC Burkhardt, JF Morehous, and AF Beck), Cincinnati, Ohio

    Department of Pediatrics (KA Copeland, D DeBlasio, MC Burkhardt, JF Morehous, and AF Beck), University of Cincinnati College of Medicine, Cincinnati, Ohio
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  • Andrew F. Beck
    Affiliations
    Cincinnati Children's Hospital Medical Center (KJ Martin, KA Copeland, Y Xu, D DeBlasio, MC Burkhardt, JF Morehous, and AF Beck), Cincinnati, Ohio

    Department of Pediatrics (KA Copeland, D DeBlasio, MC Burkhardt, JF Morehous, and AF Beck), University of Cincinnati College of Medicine, Cincinnati, Ohio
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Published:August 26, 2021DOI:https://doi.org/10.1016/j.acap.2021.08.014

      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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