Improved Outcomes Associated With Medical Home Implementation in Pediatric Primary Care

Cooley, W. Carl; McAllister, Jeanne W.; Sherrieb, Kathleen; Kuhlthau, Karen

doi:10.1542/peds.2008-2600

Cited by 207 publications

(139 citation statements)

References 16 publications

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“…22 This inconsistent association between the medical home and health-related outcomes for CSHCN highlights the need for additional studies. [23][24][25] Our study examines the association of care coordination, a key component of the medical home, with family-perceived unmet specialty care needs for CSHCN. We hypothesize that having care coordination will be associated with decreased likelihood of unmet specialty care needs for CSHCN and that this decrease in unmet need will be enhanced if the care coordination is provided within a medical home.…”

Section: Discussionmentioning

confidence: 99%

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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Section: Discussionmentioning

confidence: 99%

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

et al. 2014

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“…13,[29][30][31] Indeed, pediatric patients with asthma benefit from the utilization of a comprehensive medical home that provides continuity of care. 27,[32][33][34][35] Recent multicenter data have shown that asthma was in the top 10 admission diagnoses in pediatric patients, with the highest readmission rate of 10.6% within the first year after discharge. 5,36 These studies suggest that targeting care coordination for ambulatory care-sensitive conditions, such as asthma, may also have an impact on health care expenditures.…”

Section: Discussionmentioning

confidence: 99%

Linking Patient-Centered Medical Home and Asthma Measures Reduces Hospital Readmission Rates

et al. 2014

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OBJECTIVE: We sought to achieve 100% compliance with all 3 Children’s Asthma Care (CAC; CAC-1, CAC-2, CAC-3) measures and track attendance at follow-up appointments with the patient-centered medical home. The impact of these measures on readmission and emergency department utilization rates was evaluated. METHODS: This quality improvement study evaluated compliance with CAC measures in pediatric patients aged 2 to 18 years old hospitalized with a primary diagnosis of asthma from January 1, 2008, through June 30, 2012. A multidisciplinary Asthma Task Force was assembled to develop interventions. Attendance at the follow-up appointment was tracked monthly from January 1, 2009. Readmission and emergency department utilization rates were compared between the preimplementation period (January 1, 2006, through December 31, 2007) and the postimplementation period (January 1, 2008, through June 30, 2012). RESULTS: The preimplementation period included 231 subjects and the postimplementation period included 532 subjects. Compliance with CAC-3 was 95% from October 1, 2009, through June 30, 2012. Compliance with the postdischarge follow-up appointment was 69% from January 1, 2009 through September 30, 2009, increasing significantly to 90% from October 1, 2009, through June 30, 2012 (P < .001). Postimplementation readmission rates significantly decreased in the 91- to 180-day postdischarge interval (odds ratio: 0.29; 95% confidence interval: 0.11–0.78). CONCLUSIONS: In children hospitalized with asthma, compliance with the asthma core measures and the postdischarge follow-up appointment with the primary care provider was associated with reduced readmission rates at 91 to 180 days after discharge. We attribute our results to a comprehensive set of interventions designed by our multidisciplinary Asthma Task Force.

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“…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: Discussionmentioning

confidence: 99%

“…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%

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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Improved Outcomes Associated With Medical Home Implementation in Pediatric Primary Care

Cited by 207 publications

References 16 publications

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

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

Linking Patient-Centered Medical Home and Asthma Measures Reduces Hospital Readmission Rates

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

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