Care Coordination and Unmet Specialty Care Among Children With Special Health Care Needs

Abstract

WHAT'S KNOWN ON THIS SUBJECT: Parents of children with special health care needs and low-income children report more unmet specialty care needs. Care coordination is associated with increased and decreased referrals to specialty care, but whether care coordination is related to unmet needs is unknown.WHAT THIS STUDY ADDS: Among children with special health care needs, care coordination is associated with lower odds of unmet specialty care needs regardless of whether care coordination was received within a medical home. This association was independent of household income. abstract OBJECTIVES: Care coordination and the medical home may ensure access to specialty care. Children with special health care needs (CSHCN) have higher rates of specialty care use and unmet need compared with the general pediatric population. We hypothesized that care coordination, regardless of whether it was provided in a medical home, would decrease unmet specialty care needs among CSHCN and that the effect of care coordination would be greater among low-income families.METHODS: Secondary data analysis of participants in the 2009-2010 National Survey of CSHCN who reported unmet specialty care needs and for whom care coordination and medical home status could be determined (n = 18 905). Logistic regression models explored the association of unmet need with care coordination and medical home status adjusting for household income.RESULTS: Approximately 9% of CSHCN reported having unmet specialty care needs. Care coordination was associated with reduced odds of unmet specialty care need (without a medical home, odds ratio: 0.63, 95% confidence interval: 0.47-0.86; within a medical home, odds ratio: 0.22, 95% confidence interval: 0.16-0.29) with a greater reduction among those receiving care coordination within a medical home versus those receiving care coordination without a medical home. We did not find differences in the impact of care coordination by percentage of the federal poverty level. CONCLUSIONS:Care coordination is associated with family report of decreased unmet specialty care needs among CSHCN independent of household income. The effect of care coordination is greater when care is received in a medical home. Pediatrics

Criança dependente de tecnologia e a demanda de cuidado medicamentoso

“…The international literature further states that creating an integrated healthcare service network and coordinated care optimize access to services and inputs, reduce the volume of emergency care and hospitalizations, and lower hospital costs (23)(24) . Another facilitating factor mentioned is solidarity among the mothers of technology-dependent children, creating a new support network.…”

“…The literature values the exercise of these professionals, as they develop the knowledge and practices required to coordinate home-care (23) , with the family as the unit of care (20) . However, multi-disciplinary models are indicated to address the multiple facets of chronic conditions, with a better understanding of the psychosocial needs of these families (1,12) .…”

Immigrant Families, Children With Special Health Care Needs, and the Medical Home

“…24,30 Care coordination often becomes a challenge for CSHCNs because of the severity or complexity of their chronic conditions, requiring multiple specialists and services. 31 The measure of care coordination addresses access to mental health providers and specialists and also to nonmedical services, such as early intervention programs, schools, and special education. Studies have also shown that family-centered communication is tied closely with effective care coordination, 24,32 and differences in cultural understanding of the health care system by foreignborn parents may influence care coordination.…”

Pediatric Neurosurgery Patients Need More than a Pediatric Neurosurgeon. Part II. A Clinical Report: In the USA Lack of Parent/Caregiver Compliance Interferes with the Patient Care Sequence

“…obtained personally from some parents are listed in table 5. Boudreau et al [27] recently reported on care coordination for CSHCN and suggested that substantial payment reform will be needed for care coordination to be widely available. …”

“…It has been documented that families with less education (no education above high school level) and lower household incomes have a greater likelihood of having unmet specialty health care needs than those that are more educated and/or have higher household incomes [27]. Recommendations have been made that CSHCN and their families receive medical care in a medical home, since lack of a medical home has been associated with increased risk of foregone or delayed care [15].…”