adolescent well care visits

• HEDIS Measures and Technical Resources
• Child and Adolescent Well-Care Visits

Child and Adolescent Well-Care Visits (W30, WCV)

Well-Child Visits in the First 30 Months of Life : Assesses children who turned 15 months old during the measurement year and had at least six well-child visits with a primary care physician during their first 15 months of life. Assesses children who turned 30 months old during the measurement year and had at least two well-child visits with a primary care physician in the last 15 months.

Child and Adolescent Well-Care Visits: Assesses members 3–21 years of age who received one or more well-care visit with a primary care practitioner or an OB/GYN practitioner during the measurement year.

Why It Matters?

Assessing physical, emotional and social development is important at every stage of life, particularly with children and adolescents. 1 Well-care visits provide an opportunity for providers to influence health and development and they are a critical opportunity for screening and counseling. 2

Results – National Averages

Well child visits in the first 15 months, well child visits in the first 30 months of life (15 months – 30 months), well-child visits (ages 3-6 years): 1 or more well-child visits, child and adolescent well-care visits (total):.

This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.

Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via  my.ncqa.org  for analysis that accounts for trend breaks.

• Bright Futures. 2021. https://brightfutures.aap.org/
• Lipkin, Paul H., Michelle M. Macias, Section on Developmental and Behavioral Pediatrics Council on Children with Disabilities, Kenneth W. Norwood Jr, Timothy J. Brei, Lynn F. Davidson, Beth Ellen Davis, et al. 2020. “Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening.” Pediatrics 145 (1): e20193449. https://doi.org/10.1542/peds.2019-3449

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Physician Office Visits by Children for Well and Problem-focused Care: United States, 2012

Key findings, physician office visit rates for all visits and for well and problem-focused care were lower for children aged 6–17 than for children aged 5 and under., visit rates to general pediatricians were higher compared with visit rates to other primary care physicians and medical and surgical specialists for both types of visits., across age groups, well-care visits had recommended weight, height, and blood pressure measurements recorded more frequently compared with problem-focused visits., definitions, data source and methods, about the authors, suggested citation.

NCHS Data Brief No. 248, May 2016

PDF Version pdf icon (316 KB)

Sayeedha G. Uddin, M.D., M.P.H.; Kathleen S. O’Connor, M.P.H.; and Jill J. Ashman, Ph.D.

Data from the National Ambulatory Medical Care Survey, 2012

• Physician office visit rates for well care were lower for school-aged (those aged 6–11 years) children (31 per 100 population) and adolescents aged 12–17 years (29 per 100 population) than for younger children (349 and 74 per 100 population for children under age 1 year and 1–5 years, respectively).
• Visit rates for well and problem-focused care were highest for general pediatricians (59 and 173 per 100 population) compared with other primary (7 and 25 per 100 population) and specialty care providers (1 and 24 per 100 population) across all age groups.
• Among school-aged and adolescent children, a higher percentage of well-care visits had recommended height, weight, and blood pressure measurements recorded, compared with visits for problem-focused care.

Office visits by children can be for well or problem-focused care. Well-care visits for children routinely include assessment of emotional and social development, in addition to physical health and development ( 1 ). Problem-focused visits do not routinely include these comprehensive assessments. Receipt of well care is tracked nationally as a measure of health care quality ( 2 ). This report describes physician office visits for well and problem-focused care among children under age 18 years. This analysis complements the information on children’s visits contained in the National Ambulatory Medical Care Survey (NAMCS) 2012 online tables ( 3 ).

Keywords : well-child care, ambulatory care, National Ambulatory Medical Care Survey

• In 2012, there were approximately 171 million visits to physician offices made by children under age 18, for an overall visit rate of 232 visits per 100 population ( Figure 1 ).
• The rate of problem-focused visits (173 per 100 population) was higher than the rate of well-care visits (59 per 100 population).
• The visit rates for well care (349 per 100 population) and problem-focused care (359 per 100 population) did not differ for children under age 1, but the rates for this group were higher than for older children.
• The visit rates for children aged 1–5 for both well care and problem-focused care were higher than the rates for older children.
• The rates of well-care and problem-focused visits (31 and 139 per 100 population, respectively) for children aged 6–11 were similar to the rates for children aged 12–17 (29 and 153 per 100 population, respectively).
• Among children at least age 1, rates of problem-focused visits were higher than those of well-care visits (203 per 100 population for problem-focused visits compared with 74 per 100 population for well-care visits for those aged 1–5; 139 per 100 population compared with 31 per 100 population for those aged 6–11; and 153 per 100 population compared with 29 per 100 population for those aged 12–17).

Figure 1. Physician office visit rates for children under age 18 years, by age group and visit type: United States, 2012

1 Rate statistically significantly different from all other age groups. 2 Well-care visit rate for other primary care physicians is higher than that for medical and surgical specialists. Problem-focused visit rate for other primary care physicians is higher than that for surgical specialists. NOTES: Visit rate of 232 per 100 population based on an estimated 171,045,000 visits made to physician offices nationally by children aged 0–17 years in 2012. Well-care visits are defined as those with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9–CM) codes of V20.2–V20.3, V70.0, V70.3, V70.5, V70.8, or V70.9 in any of the three diagnosis fields. Problem-focused visits include all visits that are NOT defined as well-care visits. Access data table for Figure 1 pdf icon . SOURCE: NCHS, National Ambulatory Medical Care Survey, 2012.

• The rates of both well-care (51 per 100 population) and problem-focused visits (105 per 100 population) were highest for general pediatricians compared with all other physician specialties ( Figure 2 ).
• The rate of well-care visits was higher for other primary care physicians (7 per 100 population) compared with medical specialists (1 per 100 population) and surgical specialists (estimate does not meet standards of reliability or precision).
• The rate of problem-focused care visits was higher for other primary care physicians (25 per 100 population) compared with surgical specialists (19 per 100 population).
• The rates of visits for problem-focused care were similar between medical (24 per 100 population) and surgical specialists (19 per 100 population).

Figure 2. Physician office visit rates, by physician specialty and visit type for children under age 18 years: United States, 2012

*Estimate does not meet standards of reliability or precision. 1 Visit rate is statistically significantly higher than all other specialty groups for any type of visit. 2 Well-care visit rate for other primary care physicians is higher than that for medical and surgical specialists. Problem-focused visit rate for other primary care physicians is higher than that for surgical specialists. NOTES: Other primary care physicians include family medicine, internal medicine, and general practice. Well-care visits are defined as those with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9–CM) codes of V20.2–V20.3, V70.0, V70.3, V70.5, V70.8, or V70.9 in any of the three diagnosis fields. Problem-focused visits include all visits that are not defined as well-care visits. Access data table for Figure 2 pdf icon . SOURCE: NCHS, National Ambulatory Medical Care Survey, 2012.

• The percentage of visits with recommended weight, height, and blood pressure measurement recorded was higher for well-care visits compared with problem-focused visits for both age groups 6–11 years and 12–17 years ( Figure 3 ).
• Weight was recorded at a lower percentage of problem-focused visits for children aged 12–17 (75%) compared with children aged 6–11 (83%). No difference was observed in the percentage of well-care visits with weight recorded for children aged 6–11 (97%) compared with children aged 12–17 (97%).
• No differences were observed in the percentage of well-care visits with height measurement recorded for children aged 6–11 relative to children aged 12–17 (92% compared with 94%, respectively), and for problem-focused visits (50% compared with 52%, respectively).
• Blood pressure measurement was recorded for a greater percentage of visits made by children aged 12–17 relative to children aged 6–11 for both well-care visits and problem-focused visits (93% compared with 82%, and 50% compared with 39%, respectively).

Figure 3. Percentage of physician office visits by children aged 6–17 years with recommended weight, height, and blood pressure measurement recorded, by age group and type of visit: United States, 2012

1 Significant difference compared with the 12–17 years age group. NOTES: Percentages of visits are significantly different between well-care and problem-focused visits for each measurement and age group. Only age groups 6–11 years and 12–17 years were included because blood pressure measurement is recommended for children aged 3 years and over ( 1 ). Well-care visits are defined as those with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9–CM) codes of V20.2–V20.3, V70.0, V70.3, V70.5, V70.8, or V70.9 in any of the three diagnosis fields. Problem-focused visits include all visits that are not defined as well-care visits. Access data table for Figure 3 pdf icon . SOURCE: NCHS, National Ambulatory Medical Care Survey, 2012.

Consistent with other studies ( 2 , 4 ), visit rates for well care were generally lower for older children. The visit rates for school-aged children and adolescents were similar. General pediatricians provide the majority of care to children, including both well-care and problem-focused care visits. Recommended measurement of height, weight, and blood pressure ( 1 ) were more often documented during well-care visits, emphasizing the importance of this type of visit.

Well-care visits : Defined as those with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9–CM) ( 5 ) codes of V20.2–V20.3, V70.0, V70.3, V70.5, V70.8, or V70.9 in any of the three diagnosis fields. These visits can include care for illness or problems.

Problem-focused visit : Includes all visits that are not defined as well-care visits (see above).

Medical specialist : Includes all specialties not defined as primary care or surgical care. For a complete listing, see the 2012 Documentation ( 6 ).

Surgical specialist : Includes all specialties related to surgical care (including obstetrics and gynecology). For a complete listing, see the 2012 Documentation ( 6 ).

Other primary care specialist : Includes specialties related to general and family medicine and internal medicine. For a complete listing, see the 2012 Documentation ( 6 ).

Data for this report are from NAMCS, conducted by the National Center for Health Statistics (NCHS). NAMCS is an annual, nationally representative survey of office-based physicians and visits to their offices ( 6 ). The target universe of NAMCS is physicians classified as providing direct patient care in office-based practices. Radiologists, anesthesiologists, and pathologists are excluded, as are physicians in community health centers. In 2012, the NAMCS survey design changed, and the sample size was increased five-fold to allow for state-level estimates in the 34 most populous states ( 6 , 7 ). This sampling design change may affect trending NAMCS 2011 data with 2012 data. The sample included 9,574 in-scope physicians ( 6 ). The unweighted physician response rate was 58.7% (59.7% weighted). Participating physicians provided 76,330 visit records. The unweighted visit response rate for the 2012 survey was 39.3% (39.4% weighted). A detailed analysis of nonresponse bias was conducted by NCHS. After adjustment for nonresponse by state, census division, metropolitan status, and physician specialty categories, no or negligible biases were observed among physicians providing visit data ( 7 ).

Population estimates and standard errors were calculated in Stata/SE 13.1 software ( 8 ) to account for the complex sample design. Two-sided statistical tests at the 0.05 level were used to compare estimates and rates, and to test for significance.

Sayeedha G. Uddin, Kathleen S. O’Connor, and Jill J. Ashman are with the National Center for Health Statistics, Division of Health Care Statistics.

• American Academy of Pediatrics. Recommendations for Preventive Pediatric Health Care pdf icon external icon . 2016.
• National Committee for Quality Assurance. Healthcare Effectiveness Data and Information Set: Child and adolescent well-care visits external icon .
• NCHS. National Ambulatory Medical Care Survey: 2012 state and national summary tables pdf icon .
• Freid VM, Makuc DM, Rooks RN. Ambulatory health care visits by children: Principal diagnosis and place of visit. National Center for Health Statistics. Vital Health Stat 13(137). 1998.
• NCHS. Classification of diseases, functioning, and disability. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD–9–CM) .
• NCHS. 2012 NAMCS microdata file documentation. Hyattsville, MD. 2015.
• Hing E, Shimizu IM, Talwalkar A. Nonresponse bias in estimates from the 2012 National Ambulatory Medical Care Survey. Vital Health Stat 2(171). 2016.
• StataCorp LP. Stata/SE (Release 13.1 for Windows) [computer software]. Revised December 19, 2014.

Uddin SG, O’Connor KS, Ashman JJ. Physician office visits by children for well and problem-focused care: United States, 2012. NCHS data brief, no 248. Hyattsville, MD: National Center for Health Statistics. 2016.

Copyright information

All material appearing in this report is in the public domain and may be reproduced or copied without permission; citation as to source, however, is appreciated.

National Center for Health Statistics

Charles J. Rothwell, M.S., M.B.A., Director Nathaniel Schenker, Ph.D., Deputy Director Jennifer H. Madans, Ph.D., Associate Director for Science

Division of Health Care Statistics

Clarice Brown, M.S., Director Alexander Strashny, Ph.D., Associate Director for Science

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• HEDIS Measures and Technical Resources
• Child and Adolescent Well-Care Visits

Child and Adolescent Well-Care Visits (W30, WCV)

Well-Child Visits in the First 30 Months of Life : Assesses children who turned 15 months old during the measurement year and had at least six well-child visits with a primary care physician during their first 15 months of life. Assesses children who turned 30 months old during the measurement year and had at least two well-child visits with a primary care physician in the last 15 months.

Child and Adolescent Well-Care Visits: Assesses children 3–21years of age who received one or more well-care visit with a primary care practitioner or an OB/GYN practitioner during the measurement year.

Why It Matters?

Assessing physical, emotional and social development is important at every stage of life, particularly with children and adolescents. 1 Well-care visits provide an opportunity for providers to influence health and development and they are a critical opportunity for screening and counseling. 2

Results – National Averages

Well child visits in the first 15 months, well child visits in the first 30 months of life (15 months – 30 months), well-child visits (ages 3-6 years): 1 or more well-child visits, child and adolescent well-care visits (total):.

This State of Healthcare Quality Report classifies health plans differently than NCQA’s Quality Compass. HMO corresponds to All LOBs (excluding PPO and EPO) within Quality Compass. PPO corresponds to PPO and EPO within Quality Compass.

Figures do not account for changes in the underlying measure that could break trending. Contact Information Products via  my.ncqa.org  for analysis that accounts for trend breaks.

• Bright Futures. 2021. https://brightfutures.aap.org/
• Lipkin, Paul H., Michelle M. Macias, Section on Developmental and Behavioral Pediatrics Council on Children with Disabilities, Kenneth W. Norwood Jr, Timothy J. Brei, Lynn F. Davidson, Beth Ellen Davis, et al. 2020. “Promoting Optimal Development: Identifying Infants and Young Children With Developmental Disorders Through Developmental Surveillance and Screening.” Pediatrics 145 (1): e20193449. https://doi.org/10.1542/peds.2019-3449

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Resources for Professionals and Health Care Providers

The WA State Department of Health, in collaboration with Healthcare Authority and the Medicaid Managed Care Organizations (MCOs) in the state, have developed tools to support healthcare providers in their efforts to provide well-child to their patients. If you have any questions about any of these tools or documents, please contact the Health Systems Unit .

Informative Flyers for Parents and Caregivers

These 8.5”x11” flyers have been developed to communicate to parents and caretakers of children the importance and benefits of the annual well-care visit. Each flyer has been translated into Spanish, Russian, and Vietnamese and are tailored for different age groups. 

Spring/Summer

Infants/Toddlers – English PDF |  Spanish PDF |  Russian PDF |  Vietnamese PDF Children – English PDF |  Spanish PDF |  Russian PDF |  Vietnamese PDF Adolescents – English PDF |  Spanish PDF |  Russian PDF |  Vietnamese PDF Young Adults – English PDF |  Spanish PDF |  Russian PDF |  Vietnamese PDF

Fall/Winter

Infants/Toddlers – English PDF |  Spanish PDF |  Russian PDF |  Vietnamese PDF Children – English PDF |  Spanish PDF |  Russian PDF |  Vietnamese PDF | Chuukese PDF Adolescents – English PDF |  Spanish PDF |  Russian PDF |  Vietnamese PDF | Chuukese PDF Young Adults – English PDF |  Spanish PDF |  Russian PDF |  Vietnamese PDF  | Chuukese PDF

Information for Providers 

Extended Hours Well-Care Visit Event Toolkit (PDF) This toolkit is a practical guide to support family and pediatric medical clinics in accurately implementing and providing efficient and satisfying well-care visit events for children and their parents/caregivers. Although developed in Washington state, the information here is relevant to other states and can be adapted to fit a range of settings, including rural and urban. The information here is designed to help clinics planning to implement a new well-care day/evening/weekend event. Clinics that have already conducted well-care events but want to review and refine their practices will also benefit from this information.  

Tips to Raise the Rate of Well-Care Visits (PDF)   This list of tips is compiled from parent comments in focus groups hosted by the Washington State Department of Health in fall 2017 and from clinics participating in the Medicaid Managed Care Organizations (MCO) Collaborative PIP’s Empanelment and Well-Care Visit (WCV) Projects.

Personalized Messages Ages 3 to 11 (PDF) These messages are based on AAP Bright Futures offering age specific messaging for ages 3-11. They were developed by Peninsula Community Health System while participating in the Medicaid Managed Care Organizations (MCO) Collaborative PIP’s Well-Care Visit (WCV) Projects in coordination with Washington Department of Health.

Links to Other Provider Resources

• Infants, Children, and Teens Links and Services – A list of links to resources and services for families and providers. 
• Teens and Young Adult Resources – Links to resources for teens and young adults for families and providers.
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