Use of clinical preventive services in infants, children, and adolescents.

Abstract

At each stage from birth to young adulthood, the use of clinical preventive services (CPSs) provides an opportunity to intervene early to improve outcomes for many costly and complex conditions and to modify important disease-defining risk factors.1 A number of important provisions of the Affordable Care Act (ACA) will provide impetus to improve the use of CPSs, in particular, the provision that such services are now covered without cost sharing.2 The Centers for Disease Control and Prevention (CDC) has collected baseline data and reported detailed information on a select set of CPSs for children to serve as a benchmark to measure change following ACA implementation.3 The selected CPSs were identified by the CDC because they represent important public health issues for which CPSs exist, the service was underused before ACA implementation, and national data (largely parent and self-report or provider office-based surveys) were available to establish a baseline (defined as prior to 2012). Other important CPSs for children were not included in the report because of the lack of national data to track the clinical service (eg, screening for body mass index was considered, but surveillance data on screening in clinical care were not available), or the utilization of the CPS was already at high levels (eg, many infant immunizations). Not all of the CPSs included in the CDC report have a US Preventive Services Task Force (USPSTF) grade A or B or a comparable evidence review process recommendation (eg, Advisory Committee on Immunization Practices); but all, with the exception of dental visits and preventive services by dentists, like dental sealants, are now covered under the ACA.3