Find information, tools and links to networks and resources for practitioners wishing to participate in quality improvement (QI) efforts. The information found here can be used at the practice level to address desired health outcomes of importance to the children and families in a particular practice, health care system, community or state.

These recommendations in the Bright Futures/AAP Periodicity Schedule represent a consensus by the AAP and Bright Futures. The AAP continues to emphasize the great importance of continuity of care in comprehensive health supervision and the need to avoid fragmentation of care.


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The Bright Futures/AAP Periodicity Schedule presents, in chart form, the screenings, assessments, physical examinations, procedures, and timing of anticipatory guidance recommended for each age-related visit in the Bright Futures Guidelines, 4th Edition. Explanatory notes and a key to the chart provide important details and references that support the recommendations. The Periodicity Schedule can be helpful to many audiences, including state Medicaid agencies, insurance companies, public health clinics and pediatric practices.



The American Academy of Pediatrics has released Achieving Bright Futures Preventive Services Coding Guidelines to provide guidance to insurers, regulators, lawmakers, and other pediatric health care stakeholders regarding the new Affordable Care Act Pediatric Preventive Services Provision.

This AAP Handbook is a companion piece to Bright Futures Guidelines for Health Supervision of Infants, Children, and Adolescents, 3rd Edition. The AAP notes that this handbook can be used in the pediatric practice and as a teaching tool for medical students, residents, and all health professionals who provide well child care. Click here to view the 5 main sections of the handbook which are each downloadable in PDF format.

The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit provides comprehensive and preventive health care services for children under age 21 who are enrolled in Medicaid. EPSDT is key to ensuring that children and adolescents receive appropriate preventive, dental, mental health, and developmental, and specialty services.

States are required to provide any additional health care services that are coverable under the Federal Medicaid program and found to be medically necessary to treat, correct or reduce illnesses and conditions discovered regardless of whether the service is covered in a state's Medicaid plan. It is the responsibility of states to determine medical necessity on a case-by-case basis.

When a screening examination indicates the need for further evaluation of an individual's health, diagnostic services must be provided. Necessary referrals should be made without delay and there should be follow-up to ensure the enrollee receives a complete diagnostic evaluation. States should develop quality assurance procedures to assure that comprehensive care is provided.

Periodicity schedules for periodic screening, vision, and hearing services must be provided at intervals that meet reasonable standards of medical practice. States must consult with recognized medical organizations involved in child health care in developing their schedules. Alternatively, states may elect to use a nationally recognized pediatric periodicity schedule (i.e., Bright Futures ). A separate dental periodicity schedule is also required.

The Health Check Program provides preventive health services, developmental screenings, behavioral assessments, hearing and vision screenings, and immunizations for children of all ages. Early detection and care can prevent health problems and lead to earlier diagnosis and treatment. The goal of the Health Check Program is to ensure children get the health care they need when they need it.

You, your employees and agents are authorized to use CPT only as contained in materials on the Texas Medicaid & Healthcare Partnership (TMHP) website solely for your own personal use in directly participating in healthcare programs administered by THHS. You acknowledge that AMA holds all copyright, trademark and other rights in CPT.

The finding of the review indicated a positive relationship between the use of the PHCHR and child immunisation uptake in LMIC. This may not be unconnected with the fact that resistance to immunisation in many HIC is quite low compared to LMIC [53,54,55]. Accordingly, both studies that assessed the effect of the PHCHR on immunisation uptake in the HIC [26,46] showed no overall effect. The positive association in LMIC could be as a result of poor awareness about immunisation, which characterised parents in many developing countries [4,56], of which the PHCHR is likely to educate parents about importance of immunisation. Although findings from this review indicated only one study [21] that reported the effect of the PHCHR on parent knowledge of immunisation, the study showed a positive effect. The finding of this study further shows beneficial effect of the PHCHR on child vitamin A supplement intake, a measure shown to be effective in reducing child mortalities [57,58]. Similarly, this study found that the use of PHCHR provided some protective effect against the risk of cognitive delay [37] and under-weight/stunted growth [34]. Both pieces of evidence were based on health promotion services uptake, notably ante-natal care visits and breast-feeding practice among mothers, which consequently affect child growth and development.

Ante-natal care (ANC) is another important preventive health service, particularly in developing countries, where maternal and child mortalities are high [58]. The finding of this study indicated a small, but significant relationship between the PHCHR (MCHH) and knowledge of recommended ANC [21], which support the review of Baequni et al. [17] that indicated a significant effect of the record book on knowledge of ANC. Similarly, this review showed that women who hold a PHCHR (MCHH) were about two times more likely to utilise the required ANC services. Poor utilisation of ANC is linked with adverse pregnancy outcomes, including preterm delivery, low birth weight and perinatal mortalities [59,60]. Therefore, providing women with PHCHR is likely to influence better pregnancy outcomes through the utilisation of recommended ANC. Another finding of this review indicated that PHCHR influence both knowledge and practice of breast-feeding among parents. This is not surprising as women who are more knowledgeable about the importance of breast feeding to the child, are more likely to put the knowledge into practice. Adequate breast feeding, particularly, exclusive breast-feeding within the first six months is associated with positive child health outcomes [61], hence the record book becomes valuable. This review further identified beneficial effect of the record book on awareness of pregnancy danger signs, particularly premature rupture of the membranes. Premature rupture of the membrane is a significant risk factor for placental infection and a cause of infant morbidities [62], which necessitates the need for early recognition and quick action. Therefore, the record book (MCHH) serves as a health education tool for women during pregnancy and the post-natal periods, which impact on infant outcomes.

This review also identified that the majority of parents from both HIC and LMIC use the record and take it to regular clinics check-ups. Similarly, proportion of data input in the record books were high, particularly baseline information and vaccinations, which are recorded by professionals, and growth/development data which are mostly recorded by parents. However, health professionals, particularly hospital doctors (GPs, paediatricians, casualty doctors) were reported as less likely to ask for the record or make inputs during consultations [22,29,49], which discourages parents toward the use of the record. Health personnel play an important role toward successful use of the health record book. Therefore, there is need for proper orientation among the professionals to be more committed in using the record, particularly, nurses and GPs who get in contact with the patients during regular visits. This in turn will results in the proper use of the record by parents, as they tend to value health information that comes directly from their healthcare providers [16].

The Joint Commission regularly updates its requirements for accreditation. As part of that process, we seek input from health care professionals and others with knowledge in a variety of settings. You can help by reading and commenting on proposed requirements related to your practice area.

The Handbook of Health Behavior Change, Fifth Edition, is a valuable resource for students at the graduate and advanced undergraduate level in the fields of public or population health, medicine, behavioral science, health communications, medical sociology and anthropology, preventive medicine, and health psychology. It also is a great reference for clinical investigators, behavioral and social scientists, and healthcare practitioners who grapple with the challenges of supporting individuals, families, and systems when trying to make impactful health behavior change. 9af72c28ce

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