Care Coordination for Children and Youth With Special Health Care Needs: A Descriptive, Multisite Study of Activities, Personnel Costs, and Outcomes

Antonelli, Richard C.; Stille, Christopher J.; Antonelli, Donna

doi:10.1542/peds.2007-2254

Cited by 155 publications

(121 citation statements)

References 9 publications

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“…21 Recent study results have suggested that it is possible to provide coordinated care in primary care settings, often most efficiently performed by nonphysicians, primarily nurses. 22 For example, care coordination would be improved if all pediatricians provided a standing order to hospitals with whom they work that specified that all of his or her patients should receive newborn hearing screening and that the results should be reported to his or her office. The pediatrician's office staff then knows to check all infants for screening results, report those that are missing, and refer newborns who require further evaluation for audiology diagnosis.…”

Section: Ensure That All Infants Have a Medical Home With Adequate Camentioning

confidence: 99%

Evaluation of the Universal Newborn Hearing Screening and Intervention Program

et al. 2010

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During the last 20 years, the number of infants evaluated for permanent hearing loss at birth has increased dramatically with universal newborn hearing screening and intervention (UNHSI) programs operating in all US states and many territories. One of the most urgent challenges of UNHSI programs involves loss to follow-up among families whose infants screen positive for hearing loss. We surveyed 55 state and territorial UNHSI programs and conducted site visits with 8 state programs to evaluate progress in reaching program goals and to identify barriers to successful follow-up. We conclude that programs have made great strides in screening infants for hearing loss, but barriers to linking families of infants who do not pass the screening to further follow-up remain. We identified 4 areas in which there were barriers to follow-up (lack of service-system capacity, lack of provider knowledge, challenges to families in obtaining services, and information gaps), as well as successful strategies used by some states to address barriers within each of these areas. We also identified 5 key areas for future program improvements: (1) improving data systems to support surveillance and follow-up activities; (2) ensuring that all infants have a medical home; (3) building capacity beyond identified providers; (4) developing family support services; and (5) promoting the importance of early detection. Pediatrics 2010;126:S19-S27

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Section: Ensure That All Infants Have a Medical Home With Adequate Camentioning

confidence: 99%

Evaluation of the Universal Newborn Hearing Screening and Intervention Program

et al. 2010

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“…We need to develop more robust prospective methods of identifying these children, potentially coupling diagnoses with more noncategorical characteristics, such as technology assistance and/or number of providers. Prospective identification coupled with effectiveness studies may improve our ability to care for these children in hospitals, with tools such as targeted medication reconciliation, 31 family-centered care, 32 teams of integrated providers in outpatient [27][28][29]33 and inpatient settings, 32 care pathways, 34 or portable medical records. 35 Finally, evidence to guide the provision of optimal inpatient health care for medically complex children remains very limited.…”

Section: Discussionmentioning

confidence: 99%

“…For example, the Institute of Medicine has prioritized evaluation of the medical home model for this population of children. [26][27][28][29] At the individual patient level, inpatient systems of care for medically complex children also need to be optimized. These fragile children are more vulnerable to safety issues in the inpatient setting.…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

“…HCUP KID includes nationally representative hospital discharges for children on the basis of a random 80% sample of pediatric discharges and 10% of uncomplicated births. Each data set includes weighted discharges (6.657, 7.291, 7.409, and 7.559 million, respectively) from hospitals (2521, 2784, 3438, and 3739, respectively) across various states (22,27,36, and 38, respectively). The HCUP KID sampling frame changed over time; the addition of more states and hospitals in later years and exclusion of short-term rehabilitation hospitals after 1997 has led to a more representative sample.…”

Section: Study Design and Settingmentioning

confidence: 99%

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Children With Complex Chronic Conditions in Inpatient Hospital Settings in the United States

2010

PEDIATRICS

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OBJECTIVES-Hospitalized children are perceived to be increasingly medically complex, but no such trend has been documented. The objective of this study was to determine whether the proportion of pediatric inpatient use that is attributable to patients with a diagnosis of one or more complex chronic condition (CCC) has increased over time and to assess the degree to which CCC hospitalizations are associated with attributes that are consistent with heightened medical complexity.METHODS-A retrospective observational study that used the 1997, 2000, 2003, and 2006 Kids Inpatient Databases examined US hospitalizations for children. Attributes of medical complexity included hospital admissions, length of stay, total charges, technology-assistance procedures, and mortality risk. RESULTS-The proportion of inpatient pediatric admissions, days, and charges increased from 1997 to 2006 for any CCC and for every CCC group except hematology. CCCs accounted for 8.9% of US pediatric admissions in 1997 and 10.1% of admissions in 2006. These admissions used 22.7% to 26.1% of pediatric hospital days, used 37.1% to 40.6% of pediatric hospital charges, accounted for 41.9% to 43.2% of deaths, and (for 2006) used 73% to 92% of different forms of technologyassistance procedures. As the number of CCCs for a given admission increased, all markers of use increased.CONCLUSIONS-CCC-associated hospitalizations compose an increasing proportion of inpatient care and resource use. Future research should seek to improve methods to identify the population of medically complex children, monitor their increasing inpatient use, and assess whether current systems of care are meeting their needs. NIH Public Access Author ManuscriptPediatrics. Author manuscript; available in PMC 2010 October 22. Chronic illness accounts for the majority of children's hospital days and dollars. 4 A smaller set of CSHCN, termed medically complex children, are perceived to use a disproportionate amount of resources, particularly in the inpatient and tertiary care settings. 5 Consistent and complete identification criteria of this subpopulation for administrative, clinical, and research purposes, however, remains elusive. 5-7 A prototypical medically complex child has a diversity of conditions and multisystem disease; may be technology-dependent; has frequent inpatient admissions; and requires multiple medications, multiple subspecialists, and optimal care coordination across inpatient and outpatient settings. 5 Previous work describing the 6.5% of children with disabilities, 8,9 the nearly 5% of children with multiple chronic conditions, 10 or children with technology dependence 5 likely described sets of children with some degree of medical complexity.For accurate attribution of health care use of medically complex children, an operational definition is needed for use in administrative data sets. One potential method to study medically complex children is to group International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes so...

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“…Substantial effort must be directed toward coordinating care across settings to integrate services centered on the comprehensive needs of patients/ families 13 and measuring performance of care-coordination activities. 15 …”

mentioning

confidence: 99%