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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Continuity of Primary Care Clinician in Early Childhood
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Continuity of Primary Care Clinician in Early Childhood

机译：幼儿早期初级保健临床医生的连续性

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Objectives. This study uses the first national data on well-child care for young children to 1) assess how many children have a specific clinician for well-child care; 2) identify the health insurance, health care setting, and child and family determinants of having a specific clinician; and 3) assess how parents choose pediatric clinicians.Methods. Data from the National Survey of Early Childhood Health (NSECH), a nationally representative survey of health care quality for young children fielded by the National Center for Health Statistics in 2000, were used to describe well-child care settings for children aged 4 to 35 months. Parents reported the child’s usual setting of well-child care, whether their child has a specific clinician for well-child care, and selection method for those with a clinician. Bivariate and logistic regression analyses are used to identify determinants of having a specific clinician and of provider selection method, including health care setting, insurance, managed care, and child and family characteristics.Results. Nearly all young children aged 4 to 35 months in the United States (98%) have a regular setting, but only 46% have a specific clinician for well-child care. The proportion of young children who have a single clinician is highest among privately insured children (51%) and lowest among publicly insured children (37%) and uninsured children (28%). In multivariate logistic regression including health care and sociodemographic factors, odds of having a specific clinician vary little by health care setting. Odds are lower for children who are publicly insured (odds ratio [OR]: 0.7; 95% confidence interval [CI]: 0.45–0.97) and for Hispanic children with less acculturated parents (OR: 0.6; 95% CI: 0.39–0.91). Odds are higher for children in a health plan with gatekeeping requirements (OR: 1.4; 95% CI: 1.02–1.88). Approximately 13% of young children with a specific clinician were assigned to that provider. Assignment rather than parent choice is more frequent for children who are publicly insured, in managed care, cared for in a community health center/public clinic, Hispanic, and of lower income and whose mother has lower education. In multivariate logistic regression, only lack of health insurance, care in a community health center, and managed care participation are associated with lack of choice.Conclusions. Anticipatory guidance is the foundation of health supervision visits and may be most effective when there is a continuous relationship between the pediatric provider and the parent. Only half of young children in the United States are reported to have a specific clinician for well-child care. Low rates of continuity are found across health care settings. Furthermore, not all parents of children with a continuous relationship exercised choice, particularly among children in safety net health care settings. These provisional findings on a new measure of primary care continuity for children raise important questions about the prevalence and determinants of continuity.
机译：目标。这项研究利用了对幼儿善良的儿童保育的第一个国家数据到1）评估有多少孩子为善良的临床医生提供善良的临床医生; 2）确定具有特定临床医生的健康保险，医疗保险环境和儿童和家庭决定因素; 3）评估父母如何选择儿科临床医生。 2000年国家卫生统计中心（2000年营业统计中心为由的幼儿卫生保健质量的国家代表性调查）用于描述4至35岁儿童的幼儿保育环境几个月。父母报告了孩子的平常设定了善良的家庭护理，无论他们的孩子是否拥有一个特定的临床医生，为临床医生提供善生的临床医生，以及选择方法。双变量和逻辑回归分析用于识别具有特定临床医生和提供者选择方法的决定因素，包括医疗保健环境，保险，管理护理和儿童和家庭特征。结果。几乎所有4至35个月龄在美国（98％）的幼儿都有常规环境，但只有46％的临床医生为善良的诊所。拥有单一临床医生的幼儿比例在私人被保险的儿童（51％）和公共被保险儿童（37％）和未经保险的儿童（28％）中最低的比例。在包括医疗保健和社会渗塑因素的多变量逻辑回归中，具有特定临床医生的几率因医疗保健环境而异。公开投保的儿童（差距率[或]：0.7; 95％置信区间[CI]）和西班牙裔儿童，父母较少的儿童（或：0.6; 95％CI：0.39-0.91 ）。卫生计划中的儿童具有良住态度要求的赔率更高（或：1.4; 95％CI：1.02-1.88）。将大约13％的特定临床医生分配给该提供商。分配而不是父母的选择更频繁地为公共投保的儿童提供管理护理，在社区卫生中心/公共诊所，西班牙裔和较低的收入中，母亲有降低教育。在多变量逻辑回归中，只缺乏健康保险，在社区卫生中心关注，管理护理参与与缺乏选择有关。结论。预期指导是卫生监督访问的基础，当儿科提供者和父母之间存在持续的关系时可能最有效。据报道，美国只有一半的幼儿有一个特定的临床医生善良。在医疗保健环境中发现了低延续的连续性。此外，并非所有具有持续关系的儿童的父母，尤其是安全网保健环境中的儿童。这些临时调查结果对儿童初级保健连续性的新措施提出了关于连续性患病率和决定因素的重要问题。

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