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Basket of Care: Preventive Care for Children Scope: Clinical preventive services and health care maintenance for children from birth (after hospital discharge) up to and including the second birthday. This basket of care is clearly described as intended for children seeking preventive healthcare and is not intended for the diagnosis and treatment of an acute or chronic condition. If an issue is identified, other guidelines and recommendations should be used to manage the condition. Excluded in this basket is active management of illness. Any organization that offers this basket must be able to maintain a complete and up-to-date patient medical record. Providers should document refusal of any basket components. Components Included / Excluded Basket components based on evidence Frequency within the first 2 yrs if evidence supports Rationale and source of evidence for recommendation Immunizations: Assure upto-date status and administration Frequency based on ACIP and CDC recommendations. Follow ACIP/CDC recommendations . Subcommittee recommends annual review of this basket as immunization schedules may change. Included *Providers cannot control supply issues and costs, therefore are not responsible for the cost of the vaccine (similar to providers not being responsible for diabetes medication costs, for example) and if CDC indicates a supply shortage of a given vaccine, it would be exempt from the basket until supply is again available. Secondhand smoke Care seat safety counseling Included Included Documentation and confirmation of completion of neonatal screening (hemoglobinopathies, phenylketonuria, hypothyroidism) Vision assessment for amblyopia Documentation and confirmation of completion of hearing screening Infant sleep positioning and SIDS counseling Included Updated 3/17/09 ICSI, Bright Futures - rear facing until ht/wt achieved as recommended by car seat manufacturer ICSI and Bright Futures Included Assess at each visit ICSI, Bright Futures Included Before 1 month of age ICSI, Bright Futures Included At initial visit ICSI Basket components based on community standard of care Problem list Family/social history Feeding and nutritional assessment Included Included Included Measuring, recording, reviewing and interpreting growth Developmental surveillance and screening Included Autism screening Included Lead screening – risk assessment. Included Bright Futures; AAP Screening for Elevated Blood Levels Included Screen if identified as at risk. *Blood test for lead levels not included in basket. Bright Futures Periodicity driven by other preventive services such as immunization schedule * TB test is not included in basket because of large variation in price for clinics with higher risk populations than others. Although there is a lack of evidence to support this, it is a caregiver expectation. This basket includes exam only, and addressing findings is outside of basket. TB risk assessment Included IHI; JCAH Bright Futures Bright Futures Weight, length and head circumference at every visit; Plotted on a growth curve Surveillance at all visits. Screen (i.e., complete validated tool) two times within basket period One screen at 15 months or later Bright Futures and AAP Bright Futures Bright Futures Physical examination Included Assess and counsel regarding fluoride intake for dental caries prevention Age specific anticipatory guidance Healthy lifestyle counseling—including obesity prevention Breastfeeding promotion Included MDH – proposed bill on dental varnishing Bright Futures Included Bright Futures Updated 3/17/09 Included Included Reinforcement at every visit Bright Futures – promote nutritional health and physical activity AAP Excluded components due to lack of evidence or expectation, or evidence exists to exclude care or service Medication reconciliation Anemia screening Medical Nutrition Therapy Updated 3/17/09 Excluded Excluded Excluded Not unique to preventive care Insufficient evidence Not a preventive service rather is a treatment for patients beginning at age 2 - beyond scope of this basket.
