Military Healthysteps Pilot Program Outcome Study

Background: In 2018, a military pediatrics clinic was one of two pilot sites chosen to implement the HealthySteps (HS) program into the military health system. HS is an evidence based pediatric primary care-based program that provides enhanced well-child visits and support between visits by utilizing the expertise of a non-clinical child development specialist called a HealthySteps Specialist (HSS). Our study sought to identify the impact of the HS program on the timeliness of well-child visits, immunizations, routine behavioral and developmental screenings, and referrals to community resources over the first 15 months of life (MOL).

Methods: We retrospectively reviewed charts of 26 HS-enrolled and 26 randomly selected age-matched non-HS enrolled children. Inclusion into the HS-enrolled group required HS enrollment at 2 MOL and remaining in the program until at least 15 MOL. We excluded children enrolled after 2 MOL from this group. Inclusion into the non-HS enrolled (control) group required empanelment in the pediatrics clinic since at least 2 MOL and remaining in the clinic until at least 15 MOL. Demographic variables obtained include: child’s gender, child’s birth order, mother’s age, active duty parent’s rank classification, and active duty parent’s gender. We examined 5 outcomes measures aligning with the American Academy of Pediatrics health supervision, immunization, and screening recommendations, and NCQA HEDIS measures: (1) completed 6 or more well-child visits in the first 15 MOL, (2) completed developmental screening at the 9 month well-child visit, (3) up-to-date on vaccinations at 15 MOL, (4) completed 3 or more post-partum depression screens in the first 6 MOL, and (5) the total number of documented referrals to community resources within the first 15 MOL.

Results: There was no statistical significance (p>0.05) between the HS-enrolled and control groups for all 5 demographic variables (Table 1). A significantly higher percentage of children in the HS-enrolled group received post-partum depression screening compared to the control group (96% vs 73.1%, p=0.021). The HS-enrolled group had a higher mean number of community resource referrals at 15 MOL of 2.46 (sd=1.14) versus the control group with a mean of 0.19 (sd=0.49). The mean difference was 2.26 (se=0.24, p<0.001). Although none of the other outcomes showed a statistically significant difference between groups (p>0.05), more children in the HS-enrolled group were up-to-date on vaccinations at 15 MOL (61.5%) versus the control group (38.5%) (Table 2).

Conclusion: The results of this study indicate the positive impacts of the military HS program on referrals to community resources and post-partum depression screening. Limitations of this study include the small population size and limited demographic information resulting from the retrospective nature of the study and pilot status of the HS program. Larger prospective studies are needed to clarify the true impact of the HS program in the military health system.