Understanding Factors Associated With Work Loss for Families Caring for CSHCN

Okumura, Megumi J.; Cleave, Jeanne Van; Gnanasekaran, Sangeeth; Houtrow, Amy J.

doi:10.1542/peds.2009-1255j

Cited by 100 publications

(98 citation statements)

References 24 publications

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“…[21][22][23] Moreover, parents of CSHCN who receive fragmented or poor-quality health care more often report having to reduce their work hours or leave the workforce altogether. [24][25][26] Health care spending for CSHCN can also be 2.5 to 20 times greater than for other children and accounts for 45% to 75% of total public and private pediatric health insurance expenditures. [27][28][29] Despite these concerns, there is a paucity of information about how payment incentives can promote care quality or spending for CSHCN.…”

Section: (Continued On Last Page)mentioning

confidence: 99%

Two-Year Impact of the Alternative Quality Contract on Pediatric Health Care Quality and Spending

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Payment arrangements that blend global budgets with pay-for-performance are proliferating. However, little is known about how these contracts affect pediatric health care quality and spending for children with and without special health care needs receiving care from large provider organizations. WHAT THIS STUDY ADDS:A prototypical global budget contract significantly improved preventive care quality measures tied to pay-for-performance, especially for children with special health care needs. It did not alter trends for spending or for quality measures that were not tied to pay-for-performance. abstract OBJECTIVE: To examine the 2-year effect of Blue Cross Blue Shield of Massachusetts' global budget arrangement, the Alternative Quality Contract (AQC), on pediatric quality and spending for children with special health care needs (CSHCN) and non-CSHCN. METHODS:Using a difference-in-differences approach, we compared quality and spending trends for 126 975 unique 0-to 21-year-olds receiving care from AQC groups with 415 331 propensity-matched patients receiving care from non-AQC groups; 23% of enrollees were CSHCN. We compared quality and spending pre (2006-2008) and post (2009-2010) AQC implementation, adjusting analyses for age, gender, health risk score, and secular trends. Pediatric outcome measures included 4 preventive and 2 acute care measures tied to pay-for-performance (P4P), 3 asthma and 2 attention-deficit/hyperactivity disorder quality measures not tied to P4P, and average total annual medical spending. RESULTS:During the first 2 years of the AQC, pediatric care quality tied to P4P increased by +1.8% for CSHCN (P , .001) and +1.2% for non-CSHCN (P , .001) for AQC versus non-AQC groups; quality measures not tied to P4P showed no significant changes. Average total annual medical spending was ∼5 times greater for CSHCN than non-CSHCN; there was no significant impact of the AQC on spending trends for children.CONCLUSIONS: During the first 2 years of the contract, the AQC had a small but significant positive effect on pediatric preventive care quality tied to P4P; this effect was greater for CSHCN than non-CSHCN. However, it did not significantly influence (positively or negatively) CSHCN measures not tied to P4P or affect per capita spending for either group.

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Section: (Continued On Last Page)mentioning

confidence: 99%

Two-Year Impact of the Alternative Quality Contract on Pediatric Health Care Quality and Spending

et al. 2014

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“…[8][9][10] The medical home also has been associated with less work loss for parents of CSHCNs and higher satisfaction with care among nonEnglish-speaking parents. 11,12 Evidence is limited, however, regarding the health of CSHCNs living in immigrant families, and their receipt of quality primary care on a national level. Previous studies highlighting the variation in child health outcomes and health care access and utilization by immigrant family type have not focused on CSHCNs.…”

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confidence: 99%

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

2016

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“…Garcia and Ortiz 84 have described similar differences in the Latino population and have offered suggestions for prereferral interventions to support culturally and linguistically different populations. As medical home personnel consider quality improvement efforts, areas for consideration might include lack of awareness of racial privilege, assumptions of the value of science over spirituality (in reference to developmental differences), importance of individual over the family group, and logistics required for higher frequency interactions with the developmental or medical community 91,92 (Table 3).…”

Section: Infants and Toddlers From Culturally Diverse Backgroundsmentioning

confidence: 99%

Early Intervention, IDEA Part C Services, and the Medical Home: Collaboration for Best Practice and Best Outcomes

Tapia¹,

Murphy²,

Norwood³

et al. 2013

Pediatrics

140

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The medical home and the Individuals With Disabilities Education Act Part C Early Intervention Program share many common purposes for infants and children ages 0 to 3 years, not the least of which is a family-centered focus. Professionals in pediatric medical home practices see substantial numbers of infants and toddlers with developmental delays and/or complex chronic conditions. Economic, health, and family-focused data each underscore the critical role of timely referral for relationship-based, individualized, accessible early intervention services and the need for collaborative partnerships in care. The medical home process and Individuals With Disabilities Education Act Part C policy both support nurturing relationships and family-centered care; both offer clear value in terms of economic and health outcomes. Best practice models for early intervention services incorporate learning in the natural environment and coaching models. Proactive medical homes provide strategies for effective developmental surveillance, family-centered resources, and tools to support high-risk groups, and comanagement of infants with special health care needs, including the monitoring of services provided and outcomes achieved.

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Understanding Factors Associated With Work Loss for Families Caring for CSHCN

Cited by 100 publications

References 24 publications

Two-Year Impact of the Alternative Quality Contract on Pediatric Health Care Quality and Spending

Two-Year Impact of the Alternative Quality Contract on Pediatric Health Care Quality and Spending

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

Early Intervention, IDEA Part C Services, and the Medical Home: Collaboration for Best Practice and Best Outcomes

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