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

Abstract

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.

Care Coordination Program for Children With Complex Chronic Conditions Discharged From a Rural Tertiary-Care Academic Medical Center

“…This period was selected to provide comparable data to previous studies in which authors evaluate 12-month health services use among children with chronic health conditions. 7,9,10 Total costs of care (including both acute and nonacute care visits to facilities in the hospital system) were determined over the same period by combining direct and indirect costs over this period. Direct costs, both fixed and variable, are those costs attributed to the patient encounter that are 20) -…”

“…In a recent study, authors found that 14% of US children with SHCNs had unmet needs for care coordination. 7 For children admitted to the hospital, the discharge process offers a unique opportunity to initiate coordination of follow-up care and prevent readmissions or ED revisits. 8 At this university-affiliated medical center, a tertiary-care regional hospital, the Center for Children with Complex and Chronic Conditions (C5) program was established in 2008 to initiate care coordination for children with CCCs in an inpatient transitional care unit and continue this coordination in a multidisciplinary outpatient C5 clinic, with home visits by a designated care coordination team.…”

Outpatient Follow-up Care After Hospital Discharge of Children With Complex Chronic Conditions at a Rural Tertiary Care Hospital

“…Such initiatives can be a cornerstone of addressing the unmet need for care coordination identified among children with special health care needs in nationwide population-based surveys. 23 The results from our study suggest that development of new care coordination programs and expansion of existing programs should prioritize improving outpatient follow-up visit completion among children with prolonged hospitalizations and children who had been admitted to the ICU. Our conclusions are limited by several aspects of the data and study design.…”

Follow-through care for high-risk infants during the COVID-19 pandemic: lessons learned from the Vermont Oxford Network

“…Infants with medical and developmental complexity require care from multiple sources and in many settings [ 14 ]. Access to medical, developmental, and care coordination services is not always a given, particularly for children whose families face social or economic disadvantage, have limited English proficiency, or live in rural areas [ 15 , 16 ]. Some high-risk infant follow-up programs have addressed barriers to, and inequities in, access to care through innovative delivery models.…”