First Advisor

Berg, Barbara

Second Advisor

Graham-Dickerson, Phyllis


Rueckert-Hartman College for Health Professions

Degree Name

Doctor of Nursing Practice


Loretto Heights School of Nursing

Document Type

Thesis - Open Access

Number of Pages

94 pages


Background: Data from the Colorado Health Department Child Health Survey (2010) confirmed particular needs for increased enrollment in Medicaid and Child Health Plan Plus (CHP+) and improved coordination of health services. Families in Adams County continue to face challenges and barriers in the Medicaid/CHP+ enrollment and retention process. Improved outreach at the local level is needed to improve access to these vital resources for children in Adams County.

Purpose: To ascertain whether a referral and tracking system in Adams County preschools will identify children with healthcare needs, improve access to the healthcare system from the preschool, and improve preventive care in coordination with a Patient Centered Medical Home (PCMH). The first outcome objective of the preschool primary prevention project included measuring the impact of preventive care access through a PCMH approach. Quantifiable measures were an increase in the numbers of children from baseline who received a referral to a PCMH. Outcome objective two involved measuring the impact of preventive care exams through a PCMH approach. Quantifiable measures included an increase in the numbers of children, from baseline, who received preventive care services in a PCMH.

Methods: The referral system was initiated with a parent survey that was included in the preschool enrollment packets and went out to 900 families in Adams County. Access to healthcare and preventive health care techniques were evaluated using the investigator's measurement tool which consisted of a Likert scale. Preschool demographic data, preschool tracking data, child demographic data, child access techniques, and child preventive techniques data were then collected and analyzed by hand.

Findings: Nine hundred families completed the initial parent survey tool in ten private preschools in Adams County. One hundred twenty six surveys were returned to the centers indicating a need for medical, dental, or mental health assistance. Five children needed medical assistance, 14 children needed dental assistance, and 11 children needed mental health assistance. Access was improved through the referral system because all children that indicated a need for medical assistance did not have a previous healthcare provider and were referred to a PCMH. Preventive exam status was not improved in this study. Both children that indicated a need for medical assistance were up to date on required exams and immunizations.

Conclusion: A centralized referral and tracking system implemented in the schools that links children to a PCMH, is an essential avenue for healthcare access and prevention in low-income families. There is ample reason to believe that the synergy of the school systems working with medical homes could have positive effects on child health and development. The school system and the medical home should be considered complementary collaborative partners in the provision of preventive healthcare in children.

Date of Award

Spring 2012

Location (Creation)

Denver, Colorado

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