Date of Award

January 2013

Document Type

Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Marjorie S. Rosenthal

Subject Area(s)

Medicine

Abstract

The purpose of this study is to determine whether group well-child care in the first year of life results in better health outcomes during early childhood. It is hypothesized that children randomized to group care, an intervention that lasted for the first 12 months of each child's life, will demonstrate improved health outcomes at 24, 30, and 36 months with respect to nutritional behaviors, weight status, and health care utilization. This research is a follow-up study of a randomized controlled trial in 2008-2009. Data for this study were obtained through chart review of inpatient, emergency, and outpatient

records. There were no significant findings to support the hypothesis that group well-child care manifests in improved health outcomes later in life. However, patients enrolled in group care did demonstrate a trend towards healthier weight status compared to standard individual care (p=.098). Total emergency department utilization was significantly greater for group participants with an average of 4.1 visits compared to 2.6 visits for individual care participants (p=0.03), although there was no difference with respect to appropriate use of emergency services. Although this study did not reveal definitive findings to suggest a positive impact of group well-child care during early childhood, further investigation is necessary. The studied sample size was limited, and rates of attrition were high. The trend toward healthier weights is encouraging and should be explored further.

Comments

This thesis is restricted to Yale network users only. This thesis is permanently embargoed from public release.

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