Consultative Care Coordination Through the Medical Home for CSHCN: A Randomized Controlled Trial

Farmer, Janet E.; Clark, Mary Jo; Drewel, Elena Harlan; Swenson, Theresa M.; Ge, Bin

doi:10.1007/s10995-010-0658-8

Cited by 74 publications

(85 citation statements)

References 18 publications

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“…Our results support study findings of a positive impact on patient experience among children with special health care needs who were part of a PCMH 14,15 and other child patient samples. 16 Together, these findings suggest that the PCMH model may hold promise for improving patient experience even if there is still a question of whether there are improvements in quality or cost over the short term.…”

Section: Discussionsupporting

confidence: 87%

Effects of Patient-centered Medical Home Transformation on Child Patient Experience

Harder

Krulewitz

Jones

et al. 2016

The Journal of the American Board of Family Medicine

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Introduction: Patient experience, 1 of 3 aims for improving health care, is rarely included in studies of patient-centered medical home (PCMH) transformation. This study examines the association between patient experience and National Committee on Quality Assurance (NCQA) PCMH transformation.Methods: This was a cross-sectional study of parent-reported child patient experience from PCMH and non-PCMH practices. It used randomly sampled experience surveys completed by 2599 patients at 29 pediatric and family medicine PCMH (n ‫؍‬ 21) and non-PCMH (n ‫؍‬ 8) practices in Vermont from 2011 to 2013. Patient experiences related to child development and prevention were assessed using the Consumer Assessment of Health care Providers and Systems (CAHPS).Results: A 10-point increase in NCQA score at PCMH practices is associated with a 3.1% higher CAHPS child prevention score (P ‫؍‬ .004). Among pediatric practices, PCMH recognition is associated with 7.7% (P < .0005) and 7.2% (P < .0005) higher CAHPS child development and prevention composite scores, respectively. Among family medicine practices, PCMH recognition is associated with 7.4% (P ‫؍‬ .001) and 11.0% (P < .0005) lower CAHPS child development and prevention composite scores, respectively.Conclusions: Our results suggest that PCMH recognition may improve child patient experience at pediatric practices and worsen experience at family medicine practices. These findings warrant further investigation into the differential influence of NCQA PCMH transformation on family medicine and pediatric practices. (J Am Board Fam Med 2016;29:60 -68.)

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Section: Discussionsupporting

confidence: 87%

Effects of Patient-centered Medical Home Transformation on Child Patient Experience

Harder

Krulewitz

Jones

et al. 2016

The Journal of the American Board of Family Medicine

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“…14,39 Our study aligns with national efforts to implement medical homes to reduce unmet specialty care. However, our findings suggest the implementation of care coordination is an effective means to decrease family-perceived unmet need as an interim step on the journey to comprehensive medical home transformation.…”

Section: Discussionmentioning

confidence: 57%

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

et al. 2014

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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

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“…31 A 2011 study in children and youth with special health care needs and their families who received care coordination and individualized care plans via a Medicaid managed care plan study reported improved satisfaction with mental health services and specialized therapies and participants were observed to have a decline in unmet needs, improved satisfaction with specialty care, and improved ratings of child health and family functioning. 32 In a busy medical practice, care coordination fosters improved productivity and efficiency by transferring the mechanics of follow-up care, referrals, equipment acquisition, letters of medical necessity, patient information, transition of care, and previous authorization to care coordinators rather than physicians. As such, efficiency ensues because physicians can spend less time on nonclinical issues for patients.…”

Section: Benefits Of and Evidence For Care Coordinationmentioning

confidence: 99%

Patient- and Family-Centered Care Coordination: A Framework for Integrating Care for Children and Youth Across Multiple Systems

Turchi¹,

Antonelli²,

Norwood³

et al. 2014

Pediatrics

258

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Understanding a care coordination framework, its functions, and its effects on children and families is critical for patients and families themselves, as well as for pediatricians, pediatric medical subspecialists/ surgical specialists, and anyone providing services to children and families. Care coordination is an essential element of a transformed American health care delivery system that emphasizes optimal quality and cost outcomes, addresses family-centered care, and calls for partnership across various settings and communities. High-quality, cost-effective health care requires that the delivery system include elements for the provision of services supporting the coordination of care across settings and professionals. This requirement of supporting coordination of care is generally true for health systems providing care for all children and youth but especially for those with special health care needs. At the foundation of an efficient and effective system of care delivery is the patient-/family-centered medical home. From its inception, the medical home has had care coordination as a core element. In general, optimal outcomes for children and youth, especially those with special health care needs, require interfacing among multiple care systems and individuals, including the following: medical, social, and behavioral professionals; the educational system; payers; medical equipment providers; home care agencies; advocacy groups; needed supportive therapies/services; and families. Coordination of care across settings permits an integration of services that is centered on the comprehensive needs of the patient and family, leading to decreased health care costs, reduction in fragmented care, and improvement in the patient/family experience of care. Pediatrics 2014;133:e1451-e1460

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Consultative Care Coordination Through the Medical Home for CSHCN: A Randomized Controlled Trial

Cited by 74 publications

References 18 publications

Effects of Patient-centered Medical Home Transformation on Child Patient Experience

Effects of Patient-centered Medical Home Transformation on Child Patient Experience

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

Patient- and Family-Centered Care Coordination: A Framework for Integrating Care for Children and Youth Across Multiple Systems

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