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Health Systems and Health Care

Why Are Health Systems and Health Care Important?   

Bright Futures

Bright Futures is a national health promotion and disease prevention initiative developed by the American Academy of Pediatrics that addresses children's health needs in the context of family and community. In addition to use in pediatric practice, many states implement Bright Futures principles, guidelines and tools to strengthen the connections between state and local programs, pediatric primary care, families, and local communities.  Bright Futures offers an opportunity to improve and maintain the health of all children and adolescents by focusing on the importance of preventing injuries.

The modern health care system not only treats child injuries, but is an important partner in preventing them. Nearly 99 percent of all infants are born in hospital and health care settings, affording the first opportunity for maternal and family guidance on child safety and injury prevention. Health care professionals’ principal injury intervention is the provision of “anticipatory guidance” focused on family-centered, developmentally-appropriate education and information that can help families prevent unintentional injuries, starting with the first ride home in a car safety seat. Anticipatory guidance is intended to alert families to children’s health issues now and those that may be encountered in the future.

Most child injuries are seen by a first responder, primary care provider, or an emergency department—the first line of defense for managing injury care. These are powerful venues for prevention messaging and for gathering data on causes and contributing factors to injuries. Safety centers and well-baby clinics in hospitals or within other health care environments can provide hands-on safety training, guidance in selecting safe products, and resources such as low cost safety products to keep children safe in the community.

Health systems and health care providers can be more actively involved in injury prevention beyond the clinical care setting through efforts including, community education, the use of advanced technology in diagnosis and treatment, and implementing innovative models of care. Primary care training programs in injury prevention could be expanded. In addition, tools such as electronic health records (EHR), integrated databases, and innovations such as the use of real-time medical monitoring devices can improve children’s health and can often be included in modifications to health care plans. Changes in health care and the health care system are important components of any plan to prevent child injuries.

Health Systems and Health Care Goals and Actions

Goal: Identify opportunities in health care reform to improve child health through injury prevention.

Health care reform has brought with it a number of potential changes that could improve child safety and reduce injuries—changes that could result in  more coverage for preventive services, better access to care, more affordable care, increased patient safety, and improvements in patient outcomes resulting from skilled care. Health care reform has the potential to advance health, reduce injuries, and improve injury care for all children.

Actions:

  • Implement child injury prevention programs through community-based prevention funding and through Bright Futures.
  • Support the inclusion of child injury risk assessment, counseling, and remediation in the Maternal, Infant and Early Childhood Home Visitation Program.
  • Develop guidelines for adopting and promoting best practices in child injury prevention throughout the health care system.
  • Augment state and local health department capacity to address child injury prevention.
  • Accelerate the translation and implementation of evidence-based interventions into the health care setting.

Goal: Integrate child injury prevention into the medical home movement.

According to the American Academy of Pediatrics, the medical home is the model for 21st Century primary care of children. A medical home is a partnership among children, their families, and their pediatric primary care teams.

Medical homes provide preventive, acute, and chronic care from birth to adulthood. Their goal is to deliver primary care that is accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective for every child. When patients receive care from their medical homes, their health status, timeliness of care, and family functioning improve. Recent studies show that the medical home reduces the difficulty of accessing medical care after regular business hours, improves the exchange and flow of critical medical information among health care providers, and reduces the duplication of medical testing and the rates of medical errors. Child injury prevention should become an integral part of this important model of care.  

Actions:

  • Create and implement injury prevention quality measures that apply to the medical home.   
  • Support the development of injury indicators for children and youth in the medical home.
  • Create partnerships between health care providers and those serving disadvantaged populations to increase availability and affordability of child safety devices for reducing injury disparities. Establish partnerships for integrated follow-up care after discharge from the hospital.
  • Promote safety devices, like child safety seats, as “durable medical equipment” so they can be prescribed and are reimbursable expenses.
  • Implement quality improvement measures for injury prevention in health plans and for medical care in the medical home, hospital, and outpatient settings (e.g., Health care Effectiveness Data and Information Set [HEDIS], National Committee for Quality Assurance [NCQA], Early and Periodic Screening, Diagnosis, and Treatment [EPSDT], and National Quality Forum [NQF]).

Goal: Expand effective health care-based services and systems to improve injury outcomes for children and youth.

Several health services and systems are already well established in U.S. health care. These include preventive care, screening for risk factors, and Maternal and Child Health services. Other systems such as Emergency Medical Services for Children (EMSC) and comprehensive trauma care systems require support and expansion to improve injury outcomes for children. Actions such as integrating injury prevention into hospital and birthing centers’ discharge planning, implementing comprehensive child safety standards for child care center operation, and incorporating injury prevention models in advanced certification programs for perinatal patient care can go far to improve prevention efforts. Other systems should be identified and analyses performed to identify similar opportunities for improving injury outcomes for children.

Actions:

  • Increase universal access to poison control centers, comprehensive trauma care systems, pre-hospital care, and preventive services.
  • Expand the scope and reach of EMSC to adequately serve rural residents and disadvantaged high-risk children and youth.
  • Enhance the capacity of maternal and child health care practices throughout the United States to fully support child injury prevention.
  • Integrate injury prevention programs, such as Bright Futures into patient safety, well-child visits, WIC services, and hospital discharge planning.
  • Create comprehensive statewide networks for home- or clinic-based care for every seriously injured child.

Goal: Increase the development and use of advanced technologies in the health care environment to prevent injuries and improve child injury outcomes.

Several advanced technologies are promising in their potential for improving access to quality care, and thus to improve patient outcomes. These technologies include electronic medical records, linked medical data systems, and technology-based preventive and therapeutic interventions. Advanced technologies   can be used and enhanced to improve injury care and injury outcomes for children. Innovations involving communication devices that record and securely transmit medical information from various settings directly to individuals’ electronic health records (EHR) is one example. Physicians and other health care providers can establish medical thresholds for individual injuries and their complications that can be tailored to each patient, allowing real time monitoring of their conditions. When medical conditions change, the provider can be alerted and treatment orders can be modified. Another important application of the EHR is integrating and embedding injury prevention anticipatory messages in every well-child visit. Innovations in technology show great promise for improving the care of child injuries and reducing associated costs.

Actions:

  • Use medical information systems and EHR to improve the speed, efficiency, and quality of care for injured children and adolescents.
  • Explore the use of linked data systems to improve treatment decisions and outcomes for injured children and adolescents.
  • Advance the use of technology-based preventive and therapeutic interventions to improve care, treatment, and rehabilitation from injury.
  • Define standards for the use of advanced technologies to improve awareness of major risks of injury during gestation and in the first year of life.  

 

 
Contact Us:
  • Centers for Disease Control and Prevention
    National Center for Injury Prevention and Control (NCIPC)
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    MS F-63
    Atlanta, GA 30341-3717
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    (800-232-4636)
    TTY: (888) 232-6348
  • Contact CDC–INFO
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800-CDC-INFO (800-232-4636) TTY: (888) 232-6348 - Contact CDC–INFO
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