Abstract
This is a prospective study to evaluate ability of a nurse care coordinator to: (1) improve ability of a pediatric clinic to meet medical home (MH) objectives and (2) improve receipt of services for families of children with special health care needs (CSHCN). A nurse was hired to provide care coordination for CSHCN in an urban, largely Medicaid pediatric academic practice. CSHCN were identified using a CSHCN Screener. Ability to meet MH criteria was determined using the MH Index (MHI). Receipt of MH services was measured using the MH Family Index (MHFI). After baseline surveys were completed, Hurricane Katrina destroyed the clinic. Care coordination was implemented for the post-disaster population. Surveys were repeated in the rebuilt clinic after at least 3 months of care coordination. The distribution of demographics, diagnoses and percent CSHCN did not significantly change pre and post Katrina. Psychosocial needs such as food, housing, mental health and education were markedly increased. Essential strategies included developing a new tool for determining complexity of needs and involvement of the entire practice in care coordination activities. MHFI showed improvement in receipt of services post care coordination and post-Katrina with P < 0.05 for 13 of 16 questions. MHI demonstrated improvement in care coordination and community outreach domains. Average cost was $36.88 per CSHCN per year. There was significant improvement in the ability of the clinic to meet care coordination and community outreach MH criteria and in family receipt of services after care coordination, despite great increase in psychosocial needs. This study provides practical strategies for implementing care coordination for families of high risk CSHCN in underserved populations.
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References
Strickland, B. (2004). Access to the medical home: Results of the national survey of children with special health care needs. Pediatrics, 113(5), 1485–1492.
Benedict, R. E. (2007). Quality medical homes: Meeting children’s needs for therapeutic and supportive services. Pediatrics, 121, e127–e134.
American Academy of Pediatrics. (2002). The medical home. Pediatrics, 110(1), 184–186.
McPherson, M., Arango, P., et al. (1998). A new definition of children with special health care needs. Pediatrics, 102(1), 137–139.
Bethell, C. D., et al. (2007). What is the prevalence of children with special health care needs? Toward an understanding of variations in findings and methods across three national surveys. Maternal and Child Health Journal, 12(1), 1–14.
Chevarley, F. M. (2006). Utilization and expenditures for children with special health care needs. Rockville, MD: Agency for Healthcare Research and Quality.
Newacheck, P. W., et al. (2004). Health services use and health care expenditures for children with disabilities. Pediatrics, 114(1), 79–85.
Newacheck, P., & Kim, S. (2005). A national profile of health care utilization and expenditures for children with special health care needs. Archives of Pediatrics and Adolescent Medicine, 159, 10–17.
Liptak, G. S., et al. (1998). Effects of providing comprehensive ambulatory services to children with chronic conditions. Archives of Pediatrics and Adolescent Medicine, 152(10), 1003–1008.
Antonelli, R., et al. (2008). Care coordination for children and youth with special health care needs: A descriptive, multisite study of activities, personnel costs and outcomes. Pediatrics, 122, e209–e216.
Wise P. H., et al. (2007). A critical analysis of care coordination strategies for children with special health care needs. In US Department of Health and Human Services.
Palfrey, J. S., et al. (2004). The pediatric alliance for coordinated care: Evaluation of a medical home model. Pediatrics, 113(5 Suppl), 1507–1516.
American Academy of Pediatrics, et al. (2007). Joint principles of the patient-centered medical home. American Academy of Pediatrics.
Patient Centered Primary Care Collaborative, National Committee for Quality Assurance. (2007). Health care leaders to use new national criteria for patient-centered medical home. Washington, DC: National Committee for Quality Assurance.
Arvantes, J., American Academy of Family Physicians. (2009). States take lead in adopting medical home model. American Academy of Family Physicians.
Gupta, V. B., et al. (2004). Care coordination services in pediatric practices. Pediatrics, 113(5 Suppl), 1517–1521.
American Academy of Pediatrics, Committee on Children with Disabilities. (2005). Care coordination in the medical home: Integrating health and related systems of care for children with special health care needs. Pediatrics, 116, 1238–1244.
Kelly, A., et al. (2007). A medical home center: Specializing in the care of children with special health care needs of high intensity. Maternal and Child Health Journal, 12, 633–640.
Snow, J. (2005). Care Coordination Final Report: Children with Special Health Care Needs Financing Initiative. Boston, MA: John Snow Inc.
McAllister, J. W., et al. (2009). Improvement in the family-centered medical home enhances outcomes for children and youth with special healthcare needs. Journal of Ambulatory Care Management, 32(3), 188–196.
Healthways, Johns Hopkins Medical Institutions. (2005). Improving care coordination through physician/disease management collaboration. In: Fifth Annual Disease Management Outcomes Summit Ft. Lauderdale, FL.
McAllister, J., et al. (2007). Practice-based care coordination: A medical home essential. Pediatrics, 1120, e723–e733.
American Academy of Pediatrics, Committee on Children with Disabilities. (1999). Care coordination: Integrating health and related systems of care for children with special health care needs. Pediatrics, 104(4), 978–981.
Antonelli, R. C., et al. (2009). Making care coordination a critical component of the pediatric health system: A multidisciplinary framework. The Commonwealth Fund.
Antonelli, R. C., & Antonelli, D. M. (2004). Providing a medical home: The cost of care coordination services in a community-based, general pediatric practice. Pediatrics, 113, 1522–1528.
Child and Adolescent Health Measurement Initiative. (2009). 2007 National Survey of Children’s Health, Data Resource Center for Child and Adolescent Health website. (http://cshcndata.org/Content/Default.aspx). Last accessed April 2010.
Child and Adolescent Health Measurement Initiative. (2008). 2005/2006 National Survey of Children with Special Health Care Needs, Data Resource Center for Child and Adolescent Health website. (http://cshcndata.org/Content/Default.aspx). Last accessed April 2010.
Cooley, W., et al. (2003). The medical home index: Development and validation of a new practice-level measure of implementation of the medical home model. Ambulatory Pediatrics, 3(4), 173–180.
The future of pediatric education II. (2000). Organizing pediatric education to meet the needs of infants, children, adolescents, and young adults in the 21st century. A collaborative project of the pediatric community. Task Force on the Future of Pediatric Education. Pediatrics, 105(1 Pt 2), 157–212.
Behrman, R. E. (2001). Special article: Postgraduate education for pediatricians. Pediatrics, 107(3), 553–557.
Bethell, C., et al. (2002). Identifying children with special health care needs: Development and evaluation of a short screening instrument. Ambulatory Pediatrics, 2, 38–47.
Exeter Pediatric Associates, et al. (2001). “HOMES” complexity index. Lebanon, NH: Center for Medical Home Improvement.
Center for Medical Home Improvement. (2001). The medical home family index: Measuring the organization and delivery of primary care for children with special health care needs 2001. Lebanon, NH: Crotched Mountain, Center for Medical Home Improvement.
Cooley, W. C., & McAllister, J. W. (2004). Building Medical Homes: Improvement Strategies in Primary Care for Children with Special Healthcare Needs. Pediatrics, 113(5), 1499–1506.
Turchi, R. M., et al. (2009). Care coordination for CSHCN: Associations with family-provider relations and family/child outcomes. Pediatrics, 124(4 Suppl), 428–434.
Van Dyck, P. C., et al. (2004). Prevalence and characteristics of children with special health care needs. Archives of Pediatrics and Adolescent Medicine, 158(9), 884–890.
Pierce, L., et al. (2007). Highly mobile children and youth with disabilities: Policies and practices in five states. Project Forum, National Association of State Directors of Special Education.
Newacheck, P., et al. (1998). An epidemiological profile of children with special health care needs. Pediatrics, 102(1), 117–123.
American Medical Association. (2010). Current Procedural Terminology CPT 2009: Professional Edition. Chicago, IL: American Medical Association.
McManus, M., et al. (2003). Medical home crosswalk to reimbursement. In: Maternal and Child Health Bureau, (ed.). US Dept of Health and Human Services, Child Health Policy Research.
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This Work was supported by Maternal and Child Health Bureau Title V Grant #B04MC11257.
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Eleanor Soltau has relocated to Atlanta, Georgia, after her involvement with this research.
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Berry, S., Soltau, E., Richmond, N.E. et al. Care Coordination in a Medical Home in Post-Katrina New Orleans: Lessons Learned. Matern Child Health J 15, 782–793 (2011). https://doi.org/10.1007/s10995-010-0641-4
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DOI: https://doi.org/10.1007/s10995-010-0641-4