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Agrawal R, Perkins J. Mending, not Ending, Fee-for-Service for Children With Medical Complexity. Hosp Pediatr 2024; 14:e18-e20. [PMID: 38105691 DOI: 10.1542/hpeds.2023-007491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Affiliation(s)
- Rishi Agrawal
- Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jane Perkins
- National Health Law Program, Chapel Hill, North Carolina
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Vasan A, Kyle MA, Venkataramani AS, Kenyon CC, Fiks AG. Inequities in Time Spent Coordinating Care for Children and Youth With Special Health Care Needs. Acad Pediatr 2023; 23:1526-1534. [PMID: 36918094 PMCID: PMC10495536 DOI: 10.1016/j.acap.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/16/2023]
Abstract
OBJECTIVE In the United States, caregivers of children and youth with special health care needs (CYSHCN) must navigate complex, inefficient health care and insurance systems to access medical care. We assessed for sociodemographic inequities in time spent coordinating care for CYSHCN and examined the association between time spent coordinating care and forgone medical care. METHODS This cross-sectional study used data from the 2018-2020 National Survey of Children's Health, which included 102,740 children across all 50 states. We described the time spent coordinating care for children with less complex special health care needs (SHCN) (managed through medications) and more complex SHCN (resulting in functional limitations or requiring specialized therapies). We examined race-, ethnicity-, income-, and insurance-based differences in time spent coordinating care among CYSHCN and used multivariable logistic regression to examine the association between time spent coordinating care and forgone medical care. RESULTS Over 40% of caregivers of children with more complex SHCN reported spending time coordinating their children's care each week. CYSHCN whose caregivers spent ≥ 5 h/wk on care coordination were disproportionately Hispanic, low-income, and publicly insured or uninsured. Increased time spent coordinating care was associated with an increasing probability of forgone medical care: 6.7% for children whose caregivers spent no weekly time coordinating care versus 9.4% for< 1 hour; 11.4% for 1 to 4 hours; and 15.8% for ≥ 5 hours. CONCLUSIONS Reducing time spent coordinating care and providing additional support to low-income and minoritized caregivers may be beneficial for pediatric payers, policymakers, and health systems aiming to promote equitable access to health care for CYSHCN.
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Affiliation(s)
- Aditi Vasan
- Department of Pediatrics (A Vasan, CC Kenyon, and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; PolicyLab and Center for Pediatric Clinical Effectiveness (A Vasan, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa; Leonard Davis Institute of Health Economics (A Vasan, AS Venkataramani, CC Kenyon, and AG Fiks), University of Pennsylvania, Philadelphia, Pa.
| | - Michael Anne Kyle
- Department of Health Care Policy (MA Kyle), Harvard Medical School and Dana Farber Cancer Institute, Boston, Mass.
| | - Atheendar S Venkataramani
- Leonard Davis Institute of Health Economics (A Vasan, AS Venkataramani, CC Kenyon, and AG Fiks), University of Pennsylvania, Philadelphia, Pa; Department of Medical Ethics and Health Policy (AS Venkataramani), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Calif.
| | - Chén C Kenyon
- Department of Pediatrics (A Vasan, CC Kenyon, and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; PolicyLab and Center for Pediatric Clinical Effectiveness (A Vasan, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa; Leonard Davis Institute of Health Economics (A Vasan, AS Venkataramani, CC Kenyon, and AG Fiks), University of Pennsylvania, Philadelphia, Pa.
| | - Alexander G Fiks
- Department of Pediatrics (A Vasan, CC Kenyon, and AG Fiks), Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa; PolicyLab and Center for Pediatric Clinical Effectiveness (A Vasan, CC Kenyon, and AG Fiks), Children's Hospital of Philadelphia, Pa; Leonard Davis Institute of Health Economics (A Vasan, AS Venkataramani, CC Kenyon, and AG Fiks), University of Pennsylvania, Philadelphia, Pa.
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3
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Litt JS, Campbell DE. High-Risk Infant Follow-Up After NICU Discharge: Current Care Models and Future Considerations. Clin Perinatol 2023; 50:225-238. [PMID: 36868707 DOI: 10.1016/j.clp.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023]
Abstract
Preterm infants are at heightened risk for chronic health problems and developmental delays compared with term-born peers. High-risk infant follow-up programs provide surveillance and support for problems that may emerge during infancy and early childhood. Although considered standard of care, program structure, content, and timing are highly variable. Families face challenges accessing recommended follow-up services. Here, the authors review common models of high-risk infant follow-up, describe novel approaches, and outline considerations for improving the quality, value, and equity of follow-up care.
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Affiliation(s)
- Jonathan S Litt
- Department of Neonatology, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA; Department of Pediatrics, Harvard Medical School; Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health.
| | - Deborah E Campbell
- Division of Neonatology, Children's Hospital at Montefiore, Weiler Einstein Campus, 1601 Tenbroeck Avenue, Bronx, NY 10461, USA; Department of Pediatrics, Albert Einstein College of Medicine
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Ming DY, Jones KA, White MJ, Pritchard JE, Hammill BG, Bush C, Jackson GL, Raman SR. Healthcare Utilization for Medicaid-Insured Children with Medical Complexity: Differences by Sociodemographic Characteristics. Matern Child Health J 2022; 26:2407-2418. [PMID: 36198851 PMCID: PMC10026355 DOI: 10.1007/s10995-022-03543-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/09/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare differences in healthcare utilization and costs for Medicaid-insured children with medical complexity (CMC) by race/ethnicity and rurality. METHODS Retrospective cohort of North Carolina (NC) Medicaid claims for children 3-20 years old with 3 years continuous Medicaid coverage (10/1/2015-9/30/2018). Exposures were medical complexity, race/ethnicity, and rurality. Three medical complexity levels were: without chronic disease, non-complex chronic disease, and complex chronic disease; the latter were defined as CMC. Race/ethnicity was self-reported in claims; we defined rurality by home residence ZIP codes. Utilization and costs were summarized for 1 year (10/1/2018-9/30/2019) by complexity level classification and categorized as acute care (hospitalization, emergency [ED]), outpatient care (primary, specialty, allied health), and pharmacy. Per-complexity group utilization rates (per 1000 person-years) by race/ethnicity and rurality were compared using adjusted rate ratios (ARR). RESULTS Among 859,166 Medicaid-insured children, 118,210 (13.8%) were CMC. Among CMC, 36% were categorized as Black non-Hispanic, 42.7% White non-Hispanic, 14.3% Hispanic, and 35% rural. Compared to White non-Hispanic CMC, Black non-Hispanic CMC had higher hospitalization (ARR = 1.12; confidence interval, CI 1.08-1.17) and ED visit (ARR = 1.17; CI 1.16-1.19) rates; Hispanic CMC had lower ED visit (ARR = 0.77; CI 0.75-0.78) and hospitalization rates (ARR = 0.79; CI 0.73-0.84). Black non-Hispanic and Hispanic CMC had lower outpatient visit rates than White non-Hispanic CMC. Rural CMC had higher ED (ARR = 1.13; CI 1.11-1.15) and lower primary care utilization rates (ARR = 0.87; CI 0.86-0.88) than urban CMC. DISCUSSION Healthcare utilization varied by race/ethnicity and rurality for Medicaid-insured CMC. Further studies should investigate mechanisms for these variations and expand higher value, equitable care delivery for CMC.
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Affiliation(s)
- David Y Ming
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Department of Pediatrics, Duke University School of Medicine, Box 102376, Durham, NC, 27710, USA.
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Michelle J White
- Department of Pediatrics, Duke University School of Medicine, Box 102376, Durham, NC, 27710, USA
| | - Jessica E Pritchard
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Bradley G Hammill
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | - George L Jackson
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, USA
- Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, Durham, NC, USA
| | - Sudha R Raman
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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Noritz G, Davidson L, Steingass K. Providing a Primary Care Medical Home for Children and Youth With Cerebral Palsy. Pediatrics 2022; 150:e2022060055. [PMID: 36404756 DOI: 10.1542/peds.2022-060055] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Cerebral palsy (CP) is the most common motor disorder of childhood, with prevalence estimates ranging from 1.5 to 4 in 1000 live births. This clinical report seeks to provide primary care physicians with guidance to detect children with CP; collaborate with specialists in treating the patient; manage associated medical, developmental, and behavioral problems; and provide general medical care to their patients with CP.
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Affiliation(s)
- Garey Noritz
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; and
| | - Lynn Davidson
- The Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Katherine Steingass
- Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio; and
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Baker CL, Ozkaynak M, Ziniel SI, Harpin SB, Makic MBF. Systems of communication in school-nurse led care coordination: A concept analysis. Nurs Forum 2022; 57:1536-1544. [PMID: 36316158 DOI: 10.1111/nuf.12824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 06/16/2023]
Abstract
AIM To analyze the concept of systems of communication in school nurse-led care coordination to develop an operational definition that will inform intervention development. BACKGROUND Communication has been identified as an essential attribute in care coordination. However, previous concept analyses of care coordination did not clearly define systems of communication or consider the context of school-based care coordination. Defining and conceptualizing systems of communication has important implications for improving school nurse-led care coordination. METHODS Concept analysis was conducted using Walker and Avant's eight-step concept analysis method. The literature was searched to identify supporting literature that was analyzed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. RESULTS Systems of communication in school nurse-led care coordination can be defined as systems wherein care team members, led by the school nurse, collaborate by communicating information and knowledge through an individualized healthcare plan that is student/family-centered and shared through information systems. Attributes require developing an individual health plan that incorporates care coordination needs, information sharing with student/family consent, and a clear delineation of team member roles. Consequences include student/family outcomes, team member knowledge, and efficiency and accuracy of information. CONCLUSIONS Concept clarification and a synthesized definition allow for more effective measurement development for effective communication in school nurse-led care coordination. Students with healthcare needs in the school environment require systems of communication that efficiently work toward school nurse-led care coordination that addresses the student's health and academic outcomes.
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Affiliation(s)
- Christina L Baker
- College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mustafa Ozkaynak
- College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Sonja I Ziniel
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, Colorado, USA
| | - Scott B Harpin
- College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mary Beth F Makic
- College of Nursing, University of Colorado, Anschutz Medical Campus, Aurora, Colorado, USA
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McCarthy D, Waugh L. The Influence of National Standards on Medicaid Managed Care Programs: Implications for Children and Youth with Special Health Care Needs. Matern Child Health J 2022; 26:1967-1975. [PMID: 35999481 DOI: 10.1007/s10995-022-03499-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 10/15/2022]
Abstract
INTRODUCTION To improve services and assure predictable costs of care for Children and Youth with Special Health Care Needs (CYSHCN), state Title V and Medicaid programs are cooperating to reconceive care systems including contracting arrangements with managed care organizations (MCOs). This article describes how a consensus-based framework, the National Standards for Systems of Care for CYSHCN, influenced the redesign of two state Medicaid managed care programs: a statewide managed care plan for children with medical complexity in Florida and a regional accountable care program serving children and adults in Colorado. METHODS Data are drawn from a recent evaluation of the National Standards, which define the core components of a comprehensive, coordinated, and family-centered system of care for CYSHCN. The authors synthesized insights from documents and semi-structured interviews with national and state stakeholders. RESULTS The states used the National Standards in different ways. Florida translated the Standards into contract provisions and holds its MCO accountable to performance targets specific to CYSHCN. In Colorado, the Standards had an indirect influence on contract provisions with regional accountable entities (RAEs) and the state's oversight of EPSDT, which helps ensure that RAEs meet their obligations to CYSHCN. Managed care leaders viewed the Standards as an impetus to sharpen quality improvement and foster whole-person care. DISCUSSION The National Standards offer a flexible framework to help states design Medicaid managed care programs and improve systems of care for CYSHCN. States can learn from one another's experiences applying the Standards in the context of their policy environments.
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Affiliation(s)
- Douglas McCarthy
- Issues Research, Inc, 7116 Falls Creek Main, Durango, CO, 81301, USA.
| | - Lisa Waugh
- Issues Research, Inc, P.O. Box 19916, Boulder, CO, 80308, USA
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Sobotka SA, Lynch E, Agrawal R. The Role of Care Coordinators for Children with Respiratory Technologies and Home Nursing. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2022; 35:49-57. [PMID: 35723661 PMCID: PMC9247673 DOI: 10.1089/ped.2021.0236] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 05/19/2022] [Indexed: 06/03/2023]
Abstract
Background: Children with respiratory technologies, particularly those with mechanical ventilation, represent a growing population that require complex home nursing, medical equipment, outpatient medical and habilitative supports to live and thrive in their community. Care coordination is essential to support these children and their families to navigate and integrate key community-based health and educational services, however, care is often fragmented and care coordination needs unmet. Therefore, to fully support children with respiratory technologies, it is critical to understand the role of care coordinators (CCs) and how to sustain this workforce. The aim of this article is to describe CCs' perspective on (1) their role in supporting families in a home care program for children with respiratory technologies and home nursing, and (2) the core components of recruiting into and sustaining the CC workforce. Methods: Semistructured interviews were conducted with 15 CC from the Division of Specialized Care for Children (DSCC) Home Care program for children with technology dependence and home nursing in Illinois. Two independent coders utilized a modified template approach and discussed to agreement to analyze transcripts. Results: CC averaged 6.6 years of CC experience; the majority had social work or nursing backgrounds. CCs' job satisfaction was derived from their role supporting hospital discharge, seeing children improve over time, and navigating challenges with families. CCs enjoyed working in a collaborative environment where they could draw from their colleagues' experience to solve problems. Job dissatisfaction and job turnover stemmed from difficult family interactions, high caseloads, and redundant and time-intensive administrative tasks, which interfered with family engagement. Conclusions: CCs for children with respiratory technologies require diverse skills, but interdisciplinary teams enable collaborative support of families. Seeing children thrive can sustain the workforce, however, CCs report challenges due to high caseloads and administrative tasks, which impede direct family involvement.
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Affiliation(s)
- Sarah A. Sobotka
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago, Chicago, Illinois, USA
| | - Emma Lynch
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago, Chicago, Illinois, USA
| | - Rishi Agrawal
- Division of Hospital-Based Medicine, Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Seidel B, De Azevedo Mazza V, Louyse Schuertz A, Trevisan Nobrega Martins Ruthes VB, Macedo LC. Percepção do profissional da Estratégia Saúde da Família no cuidado à criança com deficiência. AVANCES EN ENFERMERÍA 2022. [DOI: 10.15446/av.enferm.v40n2.91505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
Objetivo: compreender a percepção dos profissionais da Estratégia Saúde da Família sobre o cuidado às crianças com deficiências.
Materiais e método: estudo exploratório descritivo com abordagem qualitativa. A coleta de dados ocorreu no primeiro semestre de 2019. Realizaram-se entrevistas não estruturadas, com questões orientadoras referentes à percepção dos profissionais quanto ao cuidado realizado às crianças com deficiências com 33 profissionais de seis equipes de saúde, de um município da região Sul do Brasil. Utilizou-se a análise categorial temática com o auxílio do software WebQDA®.
Resultados: as categorias temáticas finais identificadas neste estudo são sobre o cuidado às crianças com deficiências na Estratégia Saúde da Família, as quais foram divididas em potencialidades e fragilidades. Com relação às potencialidades, identificaram-se a rede de atenção, dando suporte aos encaminhamentos necessários, os atendimentos realizados com priorização e equidade e a consideração da importância das famílias nos cuidados; nas fragilidades, ressaltaram-se as limitações dos serviços, que dificultam ou até impossibilitam os atendimentos, como falta de profissionais, insumos e ambiência adequada, falta de protocolos direcionando os atendimentos, falta de capacitação e desconhecimento dos direitos desse público, o que prejudica o cuidado prestado a essas crianças.
Conclusões: compreender a percepção dos profissionais que estão na assistência dessas crianças possibilita identificar as lacunas dos serviços e proporciona a valorização do pessoal de saúde; em consequência disso, favorece o direcionamento adequado de recursos, beneficiando o cuidado para as famílias de crianças com deficiência.
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Abstract
PURPOSE OF REVIEW The aim of this study was to summarize emerging elements of paediatric alternative payment models (APMs), identify strategies to address barriers in implementing paediatric APMs and share policy approaches. RECENT FINDINGS The unique health needs of children and adolescents must be considered as paediatric value-based care and APMs are developed. The longer time period for achieving cost savings, relatively few existing model tests and challenges with cross-sector data-sharing and pooled financing are barriers to the adoption of paediatric APMs. The Integrated Care for Kids (InCK) model and some state-based efforts are testing whether an integrated service delivery model combined with paediatric APMs can reduce expenditures and improve care and outcomes. However, the relative paucity of models makes it difficult to identify the most effective strategies and overall impact of paediatric APMs. SUMMARY Emerging paediatric APMs include the following key elements: developmentally appropriate approaches, paediatric-specific quality and cost measures, a focus on primary care, special considerations for children with complex healthcare needs and cross-sector integration of data, workforce and financing. A variety of strategies, rooted in cross-sector partnerships, can be pursued to address implementation barriers and ultimately support paediatric care transformation.
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Affiliation(s)
- Daniella Gratale
- National Office of Policy and Prevention, Nemours Children's Health, Washington, District of Columbia, USA
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Galligan MM, Hogan AK. The Goldilocks problem: Healthcare delivery models for children with medical complexity. Curr Probl Pediatr Adolesc Health Care 2021; 51:101127. [PMID: 35000837 DOI: 10.1016/j.cppeds.2021.101127] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Health systems have increasingly adapted elements of the medical home model in designing complex care programs for children with medical complexity (CMC). In recent years, several key complex care program designs have emerged. These programs have been shown to be effective in improving the quality and cost of care for CMC. In designing and implementing a complex care model, there are many variables a health system must consider to ensure program viability. To address CMC across the continuum of care, tertiary care systems should implement a portfolio of complex care models to accommodate the population's diverse needs. Further study is needed to establish 'gold standards' for complex care delivery models, but a major factor affecting program innovation is reimbursement, as the fee for service model does not adequately support the enhanced services required to ensure high value, high quality care for CMC. It is thus critical that stakeholders from health systems and payers align to engage in innovation in complex care delivery design and implementation. Without this partnership, advances in care delivery for CMC will be limited.
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Affiliation(s)
- Meghan M Galligan
- Department of Pediatrics, Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA 19104, United States; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA, United States; Leonard Davis Institute for Healthcare Economics, University of Pennsylvania, Philadelphia, PA, United States.
| | - Annique K Hogan
- Department of Pediatrics, Children's Hospital of Philadelphia, 3500 Civic Center Blvd, Philadelphia, PA 19104, United States
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Ming DY, Jones KA, Sainz E, Tkach H, Stewart A, Cram A, Morreale MC, Dizon S, deJong NA. Feasibility of implementing systematic social needs assessment for children with medical complexity. Implement Sci Commun 2021; 2:130. [PMID: 34802465 PMCID: PMC8606226 DOI: 10.1186/s43058-021-00237-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 11/05/2021] [Indexed: 11/21/2022] Open
Abstract
Background Children with medical complexity (CMC) have inter-related health and social needs; however, interventions to identify and respond to social needs have not been adapted for CMC. The objective of this study was to evaluate the feasibility of implementing social needs screening and assessment within pediatric complex care programs. Methods We implemented systematic social needs assessment for CMC (SSNAC) at two tertiary care centers in three phases: (1) pre-implementation, (2) implementation, and (3) implementation monitoring. We utilized a multifaceted implementation package consisting of discrete implementation strategies within each phase. In phase 1, we adapted questions from evidence-informed screening tools into a 21-item SSNAC questionnaire, and we used published frameworks to inform implementation readiness and process. In phases 2–3, clinical staff deployed the SSNAC questionnaire to parents of CMC in-person or by phone as part of usual care and adapted to local clinical workflows. Staff used shared decision-making with parents and addressed identified needs by providing information about available resources, offering direct assistance, and making referrals to community agencies. Implementation outcomes included fidelity, feasibility, acceptability, and appropriateness. Results Observations from clinical staff characterized fidelity to use of the SSNAC questionnaire, assessment template, and shared decision-making for follow-up on unmet social needs. Levels of agreement (5-point Likert scale; 1 = completely disagree; 5 = completely agree) rated by staff for key implementation outcomes were moderate to high for acceptability (mean = 4.7; range = 3–5), feasibility (mean = 4.2; range = 3–5), and appropriateness (mean = 4.6; range = 4-5). 49 SSNAC questionnaires were completed with a 91% response rate. Among participating parents, 37 (76%) reported ≥ 1 social need, including food/nutrition benefits (41%), housing (18%), and caregiver needs (29%). Staff responses included information provision (41%), direct assistance (30%), and agency referral (30%). Conclusions It was feasible for tertiary care center-based pediatric complex care programs to implement a standardized social needs assessment for CMC to identify and address parent-reported unmet social needs. Supplementary Information The online version contains supplementary material available at 10.1186/s43058-021-00237-3.
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Affiliation(s)
- David Y Ming
- Department of Pediatrics, DUMC, Duke University School of Medicine, Box 3352, Durham, NC, 27710, USA. .,Department of Medicine, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC, 27710, USA. .,Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA.
| | - Kelley A Jones
- Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA
| | - Elizabeth Sainz
- Department of Pediatrics, DUMC, Duke University School of Medicine, Box 3352, Durham, NC, 27710, USA
| | - Heidie Tkach
- Department of Pediatrics, University of North Carolina School of Medicine, 260 MacNider Building, CB#7220, Chapel Hill, NC, 27599, USA
| | - Amy Stewart
- Department of Pediatrics, University of North Carolina School of Medicine, 260 MacNider Building, CB#7220, Chapel Hill, NC, 27599, USA
| | - Ashley Cram
- University of North Carolina School of Public Health, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Madlyn C Morreale
- Department of Pediatrics, University of North Carolina School of Medicine, 260 MacNider Building, CB#7220, Chapel Hill, NC, 27599, USA.,Legal Aid of North Carolina, 224 S. Dawson St, Raleigh, NC, 27601, USA
| | - Samantha Dizon
- Department of Pediatrics, DUMC, Duke University School of Medicine, Box 3352, Durham, NC, 27710, USA.,Department of Medicine, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC, 27710, USA
| | - Neal A deJong
- Department of Pediatrics, University of North Carolina School of Medicine, 260 MacNider Building, CB#7220, Chapel Hill, NC, 27599, USA
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Shenkman E, Thompson L, Bussing R, Forrest CB, Woodard J, Sun Y, Mack J, Mistry KB, Gurka MJ. Provider Specialty and Receipt of Metabolic Monitoring for Children Taking Antipsychotics. Pediatrics 2021; 147:e20200658. [PMID: 33262265 PMCID: PMC7780961 DOI: 10.1542/peds.2020-0658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/06/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Metabolic monitoring is important for children taking antipsychotic medication, given the risk for increased BMI, impaired glucose metabolism, and hyperlipidemia. The purpose was to examine the influence of provider specialty on the receipt of metabolic monitoring. Specifically, differences in the receipt of recommended care when a child receives outpatient care from a primary care provider (PCP), a mental health provider with prescribing privileges, or both was examined. METHODS Medicaid enrollment and health care and pharmacy claims data from 2 states were used in the analyses. Providers were assigned to specialties by using a crosswalk of the National Provider Identifier numbers to specialty type. A total of 41 078 children were included. RESULTS For both states, 61% of children saw ≥1 provider type and had adjusted odds ratios for receiving metabolic monitoring that were significantly higher than those of children seeing PCPs only. For example, children seeing a PCP and a mental health provider with prescribing privileges during the year had adjusted odds of receiving metabolic monitoring that were 42% higher than those seeing a PCP alone (P < .001). CONCLUSIONS Shared care arrangements significantly increased the chances that metabolic monitoring would be done. For states, health plans, and clinicians to develop meaningful quality improvement strategies, identifying the multiple providers caring for the children and potentially responsible for ordering tests consistent with evidence-based care is essential. Provider attribution in the context of shared care arrangements plays a critical role in driving quality improvement efforts.
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Affiliation(s)
| | | | - Regina Bussing
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida
| | - Christopher B Forrest
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | | | - Yijun Sun
- Departments of Health Outcomes and Biomedical Informatics and
| | - Jasmine Mack
- Departments of Health Outcomes and Biomedical Informatics and
| | - Kamila B Mistry
- Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville, Maryland
| | - Matthew J Gurka
- Departments of Health Outcomes and Biomedical Informatics and
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14
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Value-Driven Care in Developmental-Behavioral Pediatrics, Part 1: The Value Proposition of Developmental-Behavioral Pediatrics. J Dev Behav Pediatr 2020; 40:472-478. [PMID: 31107762 DOI: 10.1097/dbp.0000000000000685] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The drive to improve quality and reduce cost of health care is leading to a value-driven transformation of the US health care landscape. This is the first of a 2-part series on value-driven care and its implications for developmental-behavioral pediatrics (DBP). Tools derived from business/manufacturing models have been applied with some success to health care to better understand and enhance value. Value can be defined most simply as health outcomes achieved per dollar spent, but there are challenges in accounting for the full cost of a cycle or episode of care. When taking into account the "five Ds"-Development, Dependency, Differential Epidemiology, Demographics, and Dollars-the potential value of pediatric care is brought into sharper focus. The field of DBP in particular has the potential to add value through prevention, integration, efficiency, standardization, and innovation. The value proposition of DBP is illustrated by focusing on particular conditions or cycles of care commonly encountered in DBP practice: (1) children 0 to 3 years of age identified as having global developmental delay, (2) recent diagnosis of complex attention-deficit hyperactivity disorder (ADHD) (ADHD plus comorbid conditions), and (3) children with autism spectrum disorder and disruptive behavior. The second part of the series focuses on quality of care, emphasizing the important challenges that lie ahead for the field of DBP in measuring outcomes of care. With a discussion of national trends and a local example of a DBP program's response to these trends, the series is intended to provoke discussion and action in the field, contribute to the demonstration of value of a DBP approach to care, and help to chart a course toward growth and sustainability of DBP in an era of value-based care.
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15
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Murphy NA, Alvey J, Valentine KJ, Mann K, Wilkes J, Clark EB. Children With Medical Complexity: The 10-Year Experience of a Single Center. Hosp Pediatr 2020; 10:702-708. [PMID: 32699000 DOI: 10.1542/hpeds.2020-0085] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Children with medical complexity (CMC) have chronic, multisystem health conditions, substantial health care needs, major functional limitations, and high resource use. They represent <1% of US children yet account for more than one-third of total pediatric health care costs. Health care systems designed for typical children do not meet the unique needs of CMC. In this special article, we describe the experience of our Comprehensive Care Program for CMC in a pediatric tertiary care center, from its launch in 2007 to its present model. We review the literature, describe our collective lessons learned, and offer suggestions for future directions.
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Affiliation(s)
- Nancy A Murphy
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah;
| | - Justin Alvey
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Karen J Valentine
- Intermountain Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, Utah; and.,Healthcare Delivery Institute, Intermountain Healthcare, Murray, Utah
| | - Kilby Mann
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
| | - Jacob Wilkes
- Intermountain Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, Utah; and
| | - Edward B Clark
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah
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16
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Improving outcomes through care coordination: Measuring care coordination of nurse practitioners. J Am Assoc Nurse Pract 2019; 31:476-481. [DOI: 10.1097/jxx.0000000000000276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Kuo DZ. The Medical Home for Children with Medical Complexity: Back to Basics. J Pediatr 2019; 206:8-9. [PMID: 30553538 DOI: 10.1016/j.jpeds.2018.11.050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 11/28/2018] [Indexed: 10/27/2022]
Affiliation(s)
- Dennis Z Kuo
- Department of Pediatrics University at Buffalo Buffalo, New York.
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18
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Coller RJ, Ehlenbach ML. Making Time to Coordinate Care for Children With Medical Complexity. Pediatrics 2019; 143:peds.2018-2958. [PMID: 30584058 DOI: 10.1542/peds.2018-2958] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/22/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ryan J Coller
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
| | - Mary L Ehlenbach
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
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19
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Russell CJ. Complication Versus Consequence: Defining Device-Related Outcomes in Children With Medical Complexity. Hosp Pediatr 2019; 9:70-71. [PMID: 30530804 DOI: 10.1542/hpeds.2018-0230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Christopher J Russell
- Division of Hospital Medicine, Children's Hospital Los Angeles, Los Angeles, California; and Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
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