A "medical home" provides accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care. This study implemented and evaluated the pilot phase of a pediatric practice-directed medical home quality improvement (QI) project focused on improving primary care for children and youth with special health care needs (CYSHCN). Six practices received training, QI team development and facilitation, and receipt of mini-grants for QI projects. Practice-level and parent-level evaluations were obtained at pre-intervention and post-intervention. The intervention was well-received. Many areas of improvement were found on practice-level evaluations, especially family-centered care and QI activities. Poor response rates limited the interpretation of family-level outcomes; 26% completed baseline outcome evaluations, and 64% of initial respondents completed them post-intervention. Practice education and implementation of QI teams to plan individualized strategies for the practice are feasible ways to seek to improve outcomes for CYSHCN. Modifications of evaluation strategies are needed to enhance response rates for family-level evaluations.
Coordination of health services is important for all children and all adults, but it is particularly important for children with special health care needs. The variation in the need for care coordination both within and across states underscores the need for flexibility in program and policy development for CSHCN.
Four hundred children with streptococcal pharyngitis were treated randomly with single injections in groups of 100 each (1) with 600,000 units of penicillin G benzathine, (2) 1.2 million units of penicillin G benzathine, (3) 600,000 units of penicillin G benzathine and 600,000 units of penicillin G procaine, or (4) 900,000 units of penicillin G benzathine and 300,000 units of penicillin G procaine. Clinical response and severity of local reaction were judged in a double-blind manner at 24, 48, and 72 hours; throat cultures were taken then, and at 10, 21, and 42 days. Although the clinical response to 900,000 units of penicillin G benzathine and 300,000 units of penicillin G procaine was equal to 1.2 million units of penicillin G benzathine, the former cleared the streptococci more quickly, greatly reduced the incidence and severity of local reactions, and offered optimal therapy for streptococcal pharyngitis in the pediatric age group.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.