Other projects will help to establish standards for organizing and managing efficient pediatric practices. Stanford University's David Bergman, M.D., is producing guidelines that will help practices provide effective and efficient care based on the latest innovations and research.

To ensure that effective approaches to care are disseminated and adopted, the Fund is supporting a number of learning collaboratives, including one with the American Academy of Pediatrics. Preliminary results from participating practices in 10 states indicate a significant increase in rates of assessing parents' strengths (from 3% to 29%), using flow sheets to ensure complete care (from 21% to 77%), and using structured developmental screening instruments during well-child visits (from 29% to 75%).

In a recent Fund survey, pediatric faculty members reported that better resident and faculty training is needed in developmental and behavioral pediatrics. Pediatric nurse practitioner programs, too, have recognized the need to strengthen their training in this area. The Fund is supporting a major effort by the Association of Faculty of Pediatric Nurse Practitioner Programs to pilot-test a new curriculum for practitioners in 20 training programs around the country. The new curriculum will be informed by a series of training modules developed with Fund support by Steve Parker, M.D., at Boston University.

In an effort to improve the skills of practicing physicians, the Fund supported Medscape to host an hour-long webcast on developmental screening in primary child care settings. The session has been accessed by more than 20,000 people, and more than 2,500 clinicians have received continuing education credit. A follow-up survey of participants showed a 29 percent increase in developmental screening in their practices.

The Child Development and Preventive Care Program will continue to seek ways to address the persistent challenges of financing preventive care. Due in part to the fragmented system of health care for children in the United States, as well as the budget constraints faced by states' Medicaid programs, equitable reimbursement for pediatric preventive care remains a continuing dilemma.