New research suggested adopting an integrated pediatric care can generate some of the same short-term positives that have made the model a preferred strategy in many adult settings.

Embedding medical, behavioral, and social services into pediatric settings led to lower rates of emergency room use and higher rates of preventive visits, according to the research.

“These early childhood advanced primary care models are really a very promising way of addressing child and family needs,” said Katherine Piwnica-Worms, MD, director of pediatric health care delivery at the New York City Health & Hospitals and clinical assistant professor in the Department of Pediatrics at New York University’s Grossman School of Medicine, New York City, who led the study.

The advanced primary care model began to grow during the 1980s based on the idea that a patient-centered approach relying on better coordination of clinical and behavioral care, along with social support, could improve health outcomes and lower healthcare costs.

While advanced primary care for adult patients has continued to expand, less investment has gone toward developing primary care models for early childhood due to a lack of evidence showing such programs can generate short-term cost savings.

The study, published in Pediatrics, analyzed claims data collected from 2020 to 2022 among Medicaid enrollees who received care at special intervention clinics to those seen at conventional sites.

The intervention, called 3-2-1 Integrated Model for Parents and Children Together (IMPACT), was launched in 2020 by New York City Health & Hospitals to deliver wraparound services for children up to age 3. In addition to medical services, patients are offered services for mental health, early childhood development, social needs, and parental training.

For the analysis, 6045 children at IMPACT sites were included, as well as 4832 children at usual care sites, which were other pediatric or primary care sites at the health system.

Receiving care at an IMPACT site was associated with a 12% decrease in visits to the emergency department per month compared to those who received care at non-IMPACT sites.

More children at the IMPACT clinics received six or more well-child visits (65.8%) than those at usual care sites (58%). The American Academy of Pediatrics recommends at least six well-child visits by the time a child reaches 15 months.

Piwnica-Worms and her team found IMPACT was also associated with a 19% increase in visits to clinical specialists and a 35% increase in visits for preventative dental care compared at conventional treatment clinics. The gains among Black and Hispanic children were even greater.

Differences between hospital inpatient use and overall Medicaid expenditures were not statistically significant but were slightly lower among patients seen at IMPACT sites.

Piwnica-Worms said integrating more services at clinic sites already familiar and trusted by community members likely helped in raising engagement by caregivers.

“The fact that we incorporated the IMPACT program within the clinics across our city that have been well-established and did not have some special program that families had to sign up for or go to another facility really helped to engender trust,” she said.

Increased advocacy and sharing of best practices of how integrated pediatric care works are “critical steps to restore and expand pediatric care access nationwide,” said Eloa Adams, MD, pediatrician and director of inpatient pediatrics quality and operations at The Permanente Medical Group in San Francisco.

He said an increased focus on pediatric care is needed, as evidence shows US children have increasing rates of obesity and chronic health conditions.

The aspects that go into integrated pediatric care such as wraparound services “grow even more urgent to ensure that all children and families receive the dedicated care they deserve,” Adams said.

The study was funded by Robin Hood. The study authors reported having no relevant financial interests.

Steven Ross Johnson is a journalist who covers public health and healthcare delivery issues.