Care coordination, medical complexity, and unmet need for prescription medications among children with special health care needs

Aboneh, Ephrem A.; Chui, Michelle A.

doi:10.1016/j.sapharm.2016.05.043

Cited by 29 publications

(30 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[21][22][23] Previous studies have described disparities in access to care coordination among CSHCN according to race, insurance coverage type, family income, and national origin. [8][9][10][11][12][13] Given recent growth in care coordination initiatives, this study aimed to estimate the prevalence and disparities of unmet need for care coordination among CSHCN using the most recent available national data. In this study, 36% of CSHCN had a caregiver-reported need for care coordination, yet only 58% of this group reported receiving adequate help.…”

Section: Discussionmentioning

confidence: 99%

“…6,[8][9][10][11][12] Prior studies describing care coordination use among CSHCN have noted a wide range of socioeconomic disparities in access to care coordination, including differences by race, insurance status, family structure, nativity, and language spoken in the home. [8][9][10][11][12][13] The present study multivariable analysis identified none of these disparities as determining the likelihood of met rather than unmet need for care coordination. Recent technological developments and health care reforms may have eased implementation of care coordination services and incentivized providers to coordinate patients' care, contributing to the absence of disparities.…”

Section: Discussionmentioning

confidence: 99%

“…Child and household characteristics were selected based on prior studies examining care coordination disparities. [8][9][10][11][12][13] Child characteristics included sex, race/ethnicity (Hispanic, non-Hispanic white, non-Hispanic black, or other), age (0-5, 6-11, or 12-17 years), presence of a mental health condition (including attention deficit hyperactivity disorder, depression, anxiety, or conduct disorder), insurance type (private, public, other, or none), and whether the child was born in the United States. Household characteristics included household income (<100%, 100%-199%, 200%-399%, or ‡400% of the federal poverty line [FPL]), whether English was the primary language spoken at home, family structure (2-parent household, mother-only household, or other), and highest education level achieved by either parent (high school or less, some college [including trade school or associate degree], bachelor degree, or postgraduate education).…”

Section: Methodsmentioning

confidence: 99%

“…7 However, access to care coordination appears to be unequal, with specific disparities noted across race, insurance status, family structure, chronic condition type, language spoken at home, and immigration status. [8][9][10][11][12][13] Understanding the need for care coordination among CSHCN, as well as the extent to which this need remains unmet, can help clarify clinical and administrative challenges in caring for these patients.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

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

Miller

Tumin

Hayes

et al. 2019

Population Health Management

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

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

Miller

Tumin

Hayes

et al. 2019

Population Health Management

View full text Add to dashboard Cite

show abstract

“…International and national studies recommend that discharge planning includes educational interventions with family members, as they need to be prepared to receive their children at home (6)(7) . The nurse has been highlighted in the literature as the most appropriate professional to develop strategies to promote knowledge with the family caregiver, to coordinate comprehensive care and the transition from hospital to home, and to advocate for CSHCN and their families, as they have specialized training and knowledge of health issues (7)(8)(9) .…”

Section: Introductionmentioning

confidence: 99%

Educational demands of family members of children with special health care needs in the transition from hospital to home

et al. 2020

View full text Add to dashboard Cite

Objectives: to analyze the educational demands of family members of children with special health care needs in the transition from hospital to home Methods: qualitative research conducted between February and June 2018, using the handbook on creativity and sensitivity dynamics, from the sensitive creative method; the participants were nine family caregivers of children admitted to a public hospital in Rio de Janeiro; the data were subjected to French discourse analysis Results: the educational demands were clinical, centered on the categories complex and continuous care, technological care, modified habits, medication, development and mixed care, and social, related to the supplies and rights of children Final Considerations: the social educational demand has emerged as a new demand to be incorporated in the care of these children. The transition from hospital to home should be progressive and have the nurse as its coordinator, with the objective of providing participatory, safe, quality care, articulated within a social network

show abstract

Effectiveness of Structured Care Coordination for Children With Medical Complexity

et al. 2023

View full text Add to dashboard Cite

ImportanceChildren with medical complexity (CMC) have chronic conditions and high health needs and may experience fragmented care.ObjectiveTo compare the effectiveness of a structured complex care program, Complex Care for Kids Ontario (CCKO), with usual care.Design, Setting, and ParticipantsThis randomized clinical trial used a waitlist variation for randomizing patients from 12 complex care clinics in Ontario, Canada, over 2 years. The study was conducted from December 2016 to June 2021. Participants were identified based on complex care clinic referral and randomly allocated into an intervention group, seen at the next available clinic appointment, or a control group that was placed on a waitlist to receive the intervention after 12 months.InterventionAssignment of a nurse practitioner–pediatrician dyad partnering with families in a structured complex care clinic to provide intensive care coordination and comprehensive plans of care.Main Outcomes and MeasuresCo-primary outcomes, assessed at baseline and at 6, 12, and 24 months postrandomization, were service delivery indicators from the Family Experiences With Coordination of Care that scored (1) coordination of care among health care professionals, (2) coordination of care between health care professionals and families, and (3) utility of care planning tools. Secondary outcomes included child and parent health outcomes and child health care system utilization and cost.ResultsOf 144 participants randomized, 141 had complete health administrative data, and 139 had complete baseline surveys. The median (IQR) age of the participants was 29 months (9-102); 83 (60%) were male. At 12 months, scores for utility of care planning tools improved in the intervention group compared with the waitlist group (adjusted odds ratio, 9.3; 95% CI, 3.9-21.9; P &lt; .001), with no difference between groups for the other 2 co-primary outcomes. There were no group differences for secondary outcomes of child outcomes, parent outcomes, and health care system utilization and cost. At 24 months, when both groups were receiving the intervention, no primary outcome differences were observed. Total health care costs in the second year were lower for the intervention group (median, CAD$17 891; IQR, 6098-61 346; vs CAD$37 524; IQR, 9338-119 547 [US $13 415; IQR, 4572-45 998; vs US $28 136; IQR, 7002-89 637]; P = .01).Conclusions and RelevanceThe CCKO program improved the perceived utility of care planning tools but not other outcomes at 1 year. Extended evaluation periods may be helpful in assessing pediatric complex care interventions.Trial RegistrationClinicalTrials.gov Identifier: NCT02928757

show abstract

Care coordination, medical complexity, and unmet need for prescription medications among children with special health care needs

Cited by 29 publications

References 14 publications

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

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

Educational demands of family members of children with special health care needs in the transition from hospital to home

Effectiveness of Structured Care Coordination for Children With Medical Complexity

Contact Info

Product

Resources

About