Effect of triage in the Dutch Preventice Child Health Care on methods of signaling and health care

The main focus of the Youth Health Care (JGZ) is protecting and promoting the
health and the physicial, mental and social development of young people (0-19
years old) through the Basic Child Health Care Tasks (basistaken) 0-19
(Ministry VWS 2003). All children are examined on a certain age by a JGZ doctor
or nurse in a preventive health research (PGO). Some of the GGD*s (municipal
health organizations) work according to triage, a new protocol that is
developed by Hulpverlening Gelderland Midden (HGM, Bezem 2006; HGM 2008). For
the same age groups as for the regular PGO, children are preselected by the
doctor*s assistant based on their care needs. Children who appear healthy will
not be sent to the doctor by the doctor*s assistant, children with care needs
are send to the doctor for further examination. The aim of the triage method is
to provide more efficient health care, by paying more attention to identify and
monitor children that might be at risk.
The effects of the triage method in the JGZ are not studied yet. In 2009/2010
TNO, HGM, GGD Zuid-Holland West and Centrum Jeugdgezondheid conducted a pilot
study in which the possibilities of (effect) research focused on the triage
method were explored (Kocken, 2010). The pilot showed that the data that is
registered by the GGD*s can be used for analysis. There is a urgent need for
studies focused on the effects of the triage method. This study therefore is a
follow-up of the small scale pilot study.

The objective of this study is to gain insight in the effects of the triage
method on the identification of children with mental or physical problems, the
basic JGZ care for children age 4-12, the extra care for children with mental
or physical problems and the costs of JGZ, in order to be able to make an
informed choice concerning the way the JGZ care and the identification of
children at risk by the JGZ can be organized.
The study will provide insight in:
1. The effectiveness of the identification of children with mental or physical
problems in the JGZ basic care provided following the triage method and the
regular PGO;
2. The basic and extra care that is provided to children by the GGD*s that work
according to the triage method and the regular PGO;
3. Time and costs that are spend on basic care and extra care by the GGD*s that
work according to the triage method and the regular PGO.

Research questions:
1. What is the effect of the triage method on the identification of children
with mental or physical problems and care by the JGZ?
1a. Do JGZ professionals working according to the triage method find a similar
percentage of children with mental or physical problems as JGZ professionals
working according to the regular PGO?
1b. What is the effect of the triage method on the basic care and care for
children with mental or physical problems in comparison to the regular PGO?
2. What is the effect of the triage method on the costs of care?
3. What recommendation can be made based on this study concerning the
implementation and use of the triage method?

This is an observational study, in which two methods, triage and PGO, are
compared in terms of effectiveness (quality of care, time, costs).

The project planning contists of four phases.
Phase 1: April 2011 - May 2011

1a. Mapping the care process of the GGD*s: protocols and methods, use of
digital files (digitaal dossier). Deciding which GGD*s can participate.
1b. Deciding what data should be collected. Analysis of digital files, in order
to decide what data can be registered in the digital files and what data should
be collected separately. Designing forms for separate data collection.
1c. Contact METC
1d. Organization of secretariat of project team and setting up advisory team.

Fase 2: May 2011 * November 2011

2a. Planning registration of necessary data
- Design of database (preferably within digital file) and if necessary
registration form for identification of visual problems, overweight/obese and
psychosocial problems
- Design of letter and selection of questionnaire for parents of children that
are invited for triage/PGO or that are send to the JGZ outside of the
conventional group 2 and 7 examination (zij-instroom)
- Design of non response questionnaire for JGZ professional
- Designing sample selection process for this study
- Designing sample selection process for CBCL questionnaire

2b. Planning of registration of health care use
- Designing method to measure health care use for children with visual
problems, overweight/obese and psychosocial problems
- Designing questionnaire for JGZ professionals for examination on indication
- Designing questionnaire and letter for external care professional
2c. Designing registration of time and costs
2d. Organization of secretariat of project team and advisory committee

Phase 3: December 2011 * June 2012
3a. Briefing GGD*s
- Setting up briefing
- Setting up meeting for each GGD separately
- Provide GGD with necessary documents

3b. Sending CBCL questionnaire to parents
- Making sample for CBCL
- Sending questionnaires together with invitation letter for examination by GGD
3c. Collecting data (intake January/February, follow-up until one year after
intake)
- Collecting CBCL
- Collecting questionnaires
- Collecting registration forms and registration in digital file
- Collecting non response data
- Measure costs of health care for triage/PGO

3d. Contact external care professional for questionnaires
3e. Delivering first dataset
3f. Process data
- Data entry
- Linking files
- Checking for missing data
- First analysis
3g. Organization of secretariat of project team and advisory committee

Phase 4: July 2012 * March 2013
4a. Delivering final data set
4b. Process data
- Data entry
- Linking files
- Checking for missing data
- Data analysis
4c. Analyse data
- Identification of mental and physical problems
- Use of health care
- Costs of health care
4d. Organization of focus group interview with parents
- Deciding what parents can participate
- Contacting parents
- Organizing focus group interview
- Reporting results focus group interview

4e. Organization of meeting with advise group to discuss results
- Formulating recommendations

4f. Writing report

4g. Organization of secretariat of project team and advisory committee

This study is an observational study, in which the regular health examination
for children in group 2 and 7 is observed. The children experience no
differences caused by this study.

A selection of the parents of the children will be asked to fill out a
questionnaire (CBCL). One third of the parents of the children in the sample
will receive this questionnaire, as well as the parents of children for which
the JGZ professionals observe a psychosocial problem. Filling out the
questionnaire takes approximately 15 minutes.