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

The First 1000Days program will examine the effectiveness of an early life obesity prevention program for mother-infant pairs. If successful, the program could provide a model for chronic disease prevention and health promotion among vulnerable families starting in early life.

PURPOSE The aim of this study was to characterize essential factors to the medical home transformation of high-performing pediatric primary care practices 6 to 7 years after their participation in a national medical home learning collaborative. METHODSWe evaluated the 12 primary care practice teams having the highest Medical Home Index (MHI) scores after participation in a national medical home learning collaborative with current MHI scores, a clinician staff questionnaire (assessing adaptive reserve), and semistructured interviews. We reviewed factors that emerged from interviews and analyzed domains and subdomains for their agreement with MHI and adaptive reserve domains and subthemes using a process of triangulation.RESULTS At 6 to 7 years after learning collaborative participation, 4 essential medical home attributes emerged as drivers of transformation: (1) a culture of quality improvement, (2) family-centered care with parents as improvement partners, (3) team-based care, and ( 4) care coordination. These high-performing practices developed comprehensive, family-centered, planned care processes including fl exible access options, population approaches, and shared care plans. Eleven practices evolved to employ care coordinators. Family satisfaction appeared to stem from better access, care, and safety, and having a strong relationship with their health care team. Physician and staff satisfaction was high even while leadership activities strained personal time.CONCLUSIONS Participation in a medical home learning collaborative stimulated, but did not complete, medical home changes in 12 pediatric practices. Medical home transformation required continuous development, ongoing quality improvement, family partnership skills, an attitude of teamwork, and strong care coordination functions.Ann Fam Ann 2013;11:S90-S98. doi:10.1370/afm.1528. INTRODUCTIONT he patient-and family-centered medical home grounds US Maternal and Child Health Bureau policy and represents a strategic priority of the American Academy of Pediatrics.1,2 The Academy states that all children deserve a medical home-a source of accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective care. To date, little is known, however, about enablers of successful medical home change and whether quality improvement (QI) is an essential tool for transformation. 3 We studied 12 practices showing high performance after their participation in a QI learning collaborative to characterize attributes of transformed pediatric medical homes. METHODS S91 DR IV ER S O F MEDIC A L HO ME T R A NSF OR M AT IONhome model for children and youth with special health care needs.4 Forty-fi ve practice teams participated. Teams consisted of a pediatric physician champion, 2 "parent partners," and, optionally, a care coordinator. They completed the validated Medical Home Index (MHI) 5 before and after learning collaborative participation (data points 1 and 2). Core components of the learning collaborative included the Chro...