ABSTRACT

Presented at the Pediatric Academic Societies annual meeting, May 2001

BARRIERS TO THE PROVISION OF DEVELOPMENTAL ASSESSMENTS DURING PEDIATRIC HEALTH SUPERVISION. Neal Halfon, Miles Hochstein, Harvinder Sareen, Karen G. O'Connor, Moira Inkelas, Lynn M. Olson. Center for Healthier Children Families and Communities, UCLA, Los Angeles, CA; Department of Practice and Research, American Academy of Pediatrics, Elk Grove Village, IL.

Background: Pediatric well-child care visits can play an important role in the preventions, detection and treatment of developmental delays. However, all children do not receive recommended developmental assessments. Strategies to assure than more children receive appropriate developmental assessments need to focus on specific barriers and strategies to overcome those barriers.

Objective: To describe the barriers to the provision of developmental assessments (DA) during pediatric health supervision for children birth to 35 months of age, as a function of practice characteristics.

Design/Methods: National random sample, mailed Periodic Survey of American Academy of Pediatrics (AAP) members conducted from March to August 2000. A response rate of 66% was obtained, of whom 794 provide health supervision to children 0 to 35 months and are described here. Significance is assessed using Pearson Chi-square.

Results: Most respondents agreed that pediatricians should inquire about development (94%), felt confident in ability to advise parents (80%), reported less adequate training (65%), and only 36% agreed time was sufficient for DA. Specific barriers to DA included time limitations (80%), inability to bill/be reimbursed separately for Das and well child care (56%), inadequate reimbursement (55%), lack of non-physician staff to do DA (51%), unfamiliarity with CPT codes (46%), lack of developmental diagnostic/treatment services (34%), lack of training (28%, unfamiliarity with DA instruments for office (24%), and lack of referral programs (19%). Physicians with >50% publicly insured patients were less confident in ability to do DA (p<0.000), and less likely to have time for DA (p<0.000), and were more likely to cite barriers of lack of training (p<0.027) and lack of non-physician staff to do DA (p<0.003). Similarly, physicians with greater than 40% non-while patient population had less confidence in ability to do DA (p<0.000), and less time for DA (p<0.000), and cited several specific barriers to DA.

Conclusions: The primary barriers to DA cited by most physicians were time, barriers related to reimbursement, and staffing and practice issues. Physicians servicing minority populations and physicians with >50% Medicaid patients were less confident about and had less time for DA, and indicated that a lack of non-physician staff to do DA and inadequate referral options were barriers.