PC2129: Addressing Aces by Integrating a Parenting Assessment into Pediatric Primary Care: Time, Costs, and Impact on a Practice’s Finances

Background: The cost of ACEs to society in the U.S. is estimated at hundreds of billions of dollars per year. Some ACEs are negative parenting practices; for example, spanking is predictive of child abuse and antisocial behavior. Pediatricians are motivated to intervene for unhealthy parenting, but hurdles include time constraints and lack of reimbursement. Time and costs to integrate a parenting assessment are unknown. The objective was to estimate the time, costs, and impact on a practice’s finances to integrate a validated parenting assessment tool into the well child visit.

Methods: The Quick Parenting Assessment (QPA) is a validated, 13 item ACEs screening tool that assesses for healthy and unhealthy parenting practices. Elevated QPAs (>2) are associated with an increased likelihood of childhood behavior problems which are considered an early manifestation of exposure to toxic stress. In a clinic serving low-income parents, the QPA was integrated into the 15 month, 30 month, 5 year, and 8 year well child visits. Health care providers were educated about how to review the QPA with parents with a 20-minute presentation. After a QPA encounter, providers were invited to complete a one-page survey about the QPA review process (N=428). Key measures were the QPA score, and providers’ estimate of time required to review the QPA with parents. We estimated the range of costs of QPA integration and the impact of QPA integration on a practice’s finances.

Results: Health care providers reported that they reviewed the QPA with 88% (375/428) of parents. Of the QPAs that were reviewed, 82% (N=306) were low risk (QPA < =2) and 18% (N=69) were elevated risk (QPA >2). Most providers reported that low risk QPAs were reviewed in < = 1 minute and elevated risk QPAs in <=2 minutes. The range of cost was $1 to $6 per parenting assessment depending upon two key variables, cost of provider time and the QPA score (Table 1). The impact of the QPA on a pediatric practice’s finances varies depending upon the integration method (Table 2). If billed as a patient-focused health risk assessment, QPA implementation could lead to increased practice revenue (Table 2).

Conclusion: An ACEs screening instrument, focused on parenting, can be integrated into pediatric primary care relatively efficiently and inexpensively. The potential for health care providers to bill and be reimbursed for the QPA as a patient-focused health risk assessment could further incentivize them to routinely address parenting as part of the well child visit. These findings have implications for improving pediatric primary care, value-based care, and mitigating ACEs through the prevention of child abuse and its sequelae.