Association between unscheduled pediatric primary care visits and risk of developmental delay

OBJECTIVE:
Primary care centers are trialing open access scheduling models to expand access. Given evidence linking irregular caregiver work schedules with adverse child developmental outcomes, we hypothesized that children presenting for unscheduled “walk-in” visits would have higher odds of developmental concerns than those presenting for scheduled visits.

METHODS:
We conducted a retrospective review of electronic health record data for children aged 6-66 months visiting an academic pediatric primary care center between 7/1/2013 and 2/1/2019. Our primary outcome was presence of developmental concerns, defined by results below cutoff on a child's Ages & Stages Questionnaire, Third Edition (ASQ-3). We examined associations between visit stream (unscheduled vs. scheduled; time of day) and ASQ-3 using multivariable logistic regression, adjusting for child demographics, visit type (well-child vs. ill), and responses to a standardized social history questionnaire.

RESULTS:
Of 11,169 eligible total encounters each for a unique child, 8% were unscheduled (n=848); 19% had developmental concerns in at least one domain (n=2,100). Twenty-eight percent of children presenting for unscheduled visits had developmental concerns compared to 18% of those presenting for scheduled visits (p<.0001). Compared to those presenting for scheduled well-child visits, children presenting for unscheduled ill visits had a higher odds of an ASQ-3 score below cutoff (adjusted OR 2.02; 95% CI 1.54-2.65).

CONCLUSIONS:
As pediatric primary care centers implement open access scheduling models, they should be prepared to identify and respond to developmental concerns at a rate that may be higher than what is typically seen during scheduled visits.