Leading Health Indicator 16 Well Child Check-Up Florida 2010 Goal for Children and Youth Reduce hospitalizations, emergency room visits and preventable disease in children and youth through ongoing regularly scheduled medical visits within a medical home

Women and children who have a medical home for primary care use the emergency room less, get the appropriate care for chronic conditions and are more likely to have their immunizations up-to date.^{(1, 2), (3)}    An ongoing provider knows the family and child's health history and can identify changes in children as they grow and can help improve health outcomes for women who may have chronic illnesses or risk behaviors that could make a birth more risky. Regardless of insurance status, the older a child becomes the less likely he/she is to have a medical home or visit a medical provider.⁽²⁾

“A medical home is not a place, but a way of organizing the various resources each families needs to keep their child healthy so that families can and will access these resources.” (The Chiles Center, 2001)⁽⁴⁾   The American Academy of Pediatrics policy statement describes a medical home functionally as “accessible, continuous, comprehensive, family centered, coordinated, compassionate, and culturally effective” delivered or directed by well-trained physicians who provide primary care and help to manage and facilitate essentially all aspects of pediatric care.”⁽⁵⁾

“Well Child Check-Ups” are regularly scheduled preventive and primary health care for children, adolescents and young adults birth to age 21 that provide families and children/youths with recommended age appropriate medical care and screenings. Some important results of quality ongoing care are maintaining immunization protection levels, identification of children with special health care needs and other risk conditions, provision of special medical care and treatment, and counseling for children and families on health practices.

The American Academy of Pediatrics (13)   (AAP) provides guidance and recommendations for pediatricians and other practitioners on the health care of children. Please see the AAP website for the “Recommendations for Preventive Pediatric Health Care” Guidance (RE9939) http://www.aap.org/policy/re9939.html

The AAP guidance is organized in the form of a useful age appropriate schedule with relevant information to be considered based on best practices, research and the specific needs of a child and family. Age groupings include: infancy to 12 months of age (prenatal visits are included since a pediatrician may receive a request from a family or other provider as in the case of an at risk condition); early childhood (age 15 months through age 4), middle childhood (ages 5 through 10) and adolescence (ages 11 through 21). The major categories utilized in the current AAP “Recommendations for Preventive Pediatric Health Care” Guidance (RE9939):

Please check the AAP website. The above categories from the AAP were provided with permission from AAP. Guidances are changed or updated as new information on best practices is available. It is helpful to view the scope of areas that may be covered in an office visit, since a major objective of health care for children is to prevent disease, to periodically screen children for special health care needs and to provide early identification and treatment in order that each may reach their full potential. Ongoing, periodic visits where the recommended age specific health care guidances are available with a provider who knows the child and family are important.

Figure 82: “Well Child Check-ups” for Children Less Than Age 21 in Medicaid, Florida Fiscal Years 1995-95 to 2000-01(8)

Source: Florida Agency for Health Care Administration, Annual Report on Medicaid Outcome Measures and Medicaid Health Systems Development Office Notes: Data is on children receiving at least one check-up per year and is computed from billing files. Since reimbursement for other office visits are higher or equal to that of a well child check-up, the data is likely to under-represent the number of children receiving a well child check-up. School-age children 10 and above have much lower participation rates which lowers the over-all rate of participation.