Barriers to Care Coordination and Medical Home Implementation

Tschudy, Megan M.; Raphael, Jean L.; Nehal, Umbereen S.; O’Connor, Karen G.; Kowalkowski, Marc

doi:10.1542/peds.2015-3458

Cited by 28 publications

(23 citation statements)

References 25 publications

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“…In a recent survey, clinicians identified lack of resources as a key barrier to implementing integrated care plans in Medical Homes. 72 Finally, integrated care practice requires specific skills among providers including shared management plans, group case supervision by psychiatrists, and training for depression care managers. Further investigation is needed on how to train providers for these skills possibly taking an earlier approach to multidisciplinary training between behavioral health and medical trainees.…”

Section: Discussion and Recommendationsmentioning

confidence: 99%

Research in the Integration of Behavioral Health for Adolescents and Young Adults in Primary Care Settings: A Systematic Review

Richardson

McCarty

Radovic

et al. 2017

Journal of Adolescent Health

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Despite the recognition that behavioral and medical health conditions are frequently intertwined, the existing health care system divides management for these issues into separate settings. This separation results in increased barriers to receipt of care and contributes to problems of under-detection, inappropriate diagnosis, and lack of treatment engagement. Adolescents and young adults with mental health conditions have some of the lowest rates of treatment for their conditions of all age groups. Integration of behavioral health into primary care settings has the potential to address these barriers and improve outcomes for adolescents and young adults. In this paper, we review the current research literature for behavioral health integration in the adolescent and young adult population and make recommendations for needed research to move the field forward.

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Section: Discussion and Recommendationsmentioning

confidence: 99%

Research in the Integration of Behavioral Health for Adolescents and Young Adults in Primary Care Settings: A Systematic Review

Richardson

McCarty

Radovic

et al. 2017

Journal of Adolescent Health

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show abstract

“…Providers and family caregivers describe gaps in hospital-to-home transitions for CMC that include effective engagement and communication with families and care coordination to ensure discharge readiness [35]. Many practicing pediatricians view FCMH implementation to be vital for improving child health and resource use, yet over half describe lacking the personnel resources to facilitate the activities [36]. Finally, a lack of community-based primary care providers, especially in rural areas [37,38], limits access to the medical home for CMC.…”

Section: Introductionmentioning

confidence: 99%

Parent Perspective on Care Coordination Services for Their Child with Medical Complexity

Cady

Belew

2017

Children

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The overarching goal of care coordination is communication and co-management across settings. Children with medical complexity require care from multiple services and providers, and the many benefits of care coordination on health and patient experience outcomes have been documented. Despite these findings, parents still report their greatest challenge is communication gaps. When this occurs, parents assume responsibility for aggregating and sharing health information across providers and settings. A new primary-specialty care coordination partnership model for children with medical complexity works to address these challenges and bridge communication gaps. During the first year of the new partnership, parents participated in focus groups to better understand how they perceive communication and collaboration between the providers and services delivering care for their medically complex child. Our findings from these sessions reflect the current literature and highlight additional challenges of rural families, as seen from the perspective of the parents. We found that parents appreciate when professional care coordination is provided, but this is often the exception and not the norm. Additionally, parents feel that the local health system’s inability to care for their medically complex child results in unnecessary trips to urban-based specialty care. These gaps require a system-level approach to care coordination and, consequently, new paradigms for delivery are urgently needed.

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“…28 Specific challenges encountered by institutions seeking to develop care coordination initiatives include insufficient personnel, a lack of necessary communication skills, insufficient funding, and difficulty enrolling patients. 17,29,30 Overcoming institutional barriers may require the allocation of specific funds and personnel to care coordination, as well as leveraging technology to improve communication and coordination among services. These barriers may explain the persistence of unmet needs for care coordination among CSHCN, as confirmed in the present study.…”

Section: Discussionmentioning

confidence: 99%

Unmet Need for Care Coordination Among Children with Special Health Care Needs

Miller

Tumin

Hayes

et al. 2019

Population Health Management

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Socioeconomic disparities in access to care coordination have been noted among children with special health care needs (CSHCN). Following recent policy developments and technological innovation, care coordination has become more widespread, possibly leading to reduced disparity in care coordination access. This study investigates whether child and household characteristics remain associated with unmet need for care coordination among CSHCN. CSHCN (aged <18 years) requiring ‡2 types of health services in the past year were identified in the 2016 National Survey of Children's Health (NSCH). Care coordination was defined as help with arranging the child's care among different doctors or services. Children were classified as not needing care coordination, receiving sufficient care coordination (met need), or needing but not receiving care coordination (unmet need). Weighted multinomial logistic regression examined the association of child characteristics with this outcome. The analysis included 5622 children with no need for care coordination, 1466 with a met need, and 980 with unmet needs. Children with mental health conditions were more likely to have unmet rather than met needs for care coordination (odds ratio = 4.1; 95% confidence interval: 2.7, 6.1; P < 0.001). After multivariable adjustment, race/ethnicity, income, family structure, insurance coverage, place of birth, and use of English in the home were not associated with having unmet rather than met needs for care coordination. Among CSHCN, the latest data from NSCH reveal no evidence of previously described socioeconomic disparities in access to care coordination. Nevertheless, unmet needs for care coordination remain prevalent, especially among children with mental health conditions.

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Barriers to Care Coordination and Medical Home Implementation

Abstract: Pediatricians report a need for sufficient personnel and communication skills to provide care coordination, a core component of the FCMH. Interventions to boost FCMH implementation should focus on providing resources to develop these characteristics.

Cited by 28 publications

References 25 publications

Research in the Integration of Behavioral Health for Adolescents and Young Adults in Primary Care Settings: A Systematic Review

Research in the Integration of Behavioral Health for Adolescents and Young Adults in Primary Care Settings: A Systematic Review

Parent Perspective on Care Coordination Services for Their Child with Medical Complexity

Unmet Need for Care Coordination Among Children with Special Health Care Needs

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