596 - Well-Child Visit Adherence Within a Place-based Initiative to Address Health Disparities

Poster Number: 596
Publication Number: 596.319

Perrin B. Fugo, Case Western Reserve University School of Medicine, Cleveland Heights, OH, United States; Lasheena Brooks, UH Rainbow Babies & Children's Hospital, Maple heights, OH, United States; Mollie Evans, University Hospitals, Cleveland, OH, United States; Sarah D. Ronis, UH Rainbow Center for Child Health & Policy, Cleveland, OH, United States

Background: Place-based initiatives localize resources for children, families, and communities in geographic areas that are historically disadvantaged. In 2018, the University Hospitals Rainbow Ahuja Center for Women & Children (RCWC) launched a place-based initiative in Cleveland that co-locates pediatric primary care with ancillary health services, wrap around programs, social needs navigation, behavioral and mental health, and highly utilized specialists (e.g., allergists) to improve health outcomes among low-income families. Given that this model uses primary care to connect families to resources  it is important to understand factors associated with interruptions in well-child visits in this population.

Objective: To describe caregiver and child factors associated with attendance at well-child visits among young pediatric patients (ages 0-5 years) at RCWC 4/2020 - 10/2022.

Design/Methods: Retrospective chart review of established patients at RCWC. All healthcare system visits that occurred within one year before and one year after their identified index visit were categorized by location (RCWC, emergency department, specialist outside of the RCWC, other) and type (well-child, sick, other). Demographic data included age, sex, race, ethnicity, and payer status. Caregiver stress at the index visit was evaluated using the SEEK-PQ and a 2-item screener for caregiver stress or adult with depression/anxiety living in their home. All reviewed visits occurred during the COVID-19 pandemic.

Results: We reviewed 868 eligible patient charts. The mean age at the index visit was 1.59 years (SD=1.56), 49.5% were female, 91.2% identified as Black, and 87.0% had public insurance. 21.6% had a caregiver who reported stress or depression at the index visit. The number of children who had an adequate number of well-child visits in the year prior to their index visit (61.2% vs 65.9%, p=0.27) did not differ by caregiver mood/stress. Nor did it differ in the year after (42.0% vs 39.0%, p=0.50). Overall, the number of children with adequate number of well visits was greater in the year prior to the index visit (64.9%) than the year after (39.6%).

Conclusion(s): Adherence to recommended well-child visits did not differ based on caregiver mood/stress. Adherence rates in this population were higher than national pre-pandemic rates in the year prior to their index visit but dropped greatly in the year after. Understanding the reasons for this drop off will be critical for the future viability of this primary care-anchored model intended to address social and medical needs of low-income families.