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Larson IA, Zaniletti I, Gupta R, Wright SM, Winterer C, Toburen C, Williams K, Goodwin EJ, Northup RM, Roderick E, Hall M, Colvin JD. Accuracy of the Exeter Hospitalizations-Office Visits-Medical Conditions-Extra Care-Social Concerns Index for Identifying Children With Complex Chronic Medical Conditions in the Clinical Setting. Acad Pediatr 2023; 23:1553-1560. [PMID: 37516350 DOI: 10.1016/j.acap.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 07/20/2023] [Accepted: 07/22/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE Our objective was to determine the accuracy of a point-of-care instrument, the Hospitalizations-Office Visits-Medical Conditions-Extra Care-Social Concerns (HOMES) instrument, in identifying patients with complex chronic conditions (CCCs) compared to an algorithm used to identify patients with CCCs within large administrative data sets. METHODS We compared the HOMES to Feudtner's CCCs classification system. Using administrative algorithms, we categorized primary care patients at a children's hospital into 3 categories: no chronic conditions, non-complex chronic conditions, and CCCs. We randomly selected 100 patients from each category. HOMES scoring was completed for each patient. We performed an optimal cut-point analysis on 80% of the sample to determine which total HOMES score best identified children with ≥1 CCC and ≥2 CCCs. Using the optimal cut points and the remaining 20% of the study population, we determined the odds and area under the curve (AUC) of having ≥1 CCC and ≥2 CCCs. RESULTS The median (interquartile range [IQR]) age was 4 (IQR: 0, 8). Using optimal cut points of ≥7 for ≥1 CCC and ≥11 for ≥2 CCCs, the odds of having ≥1 CCC was 19 times higher than lower scores (odds ratio [OR] 19.1 [95% confidence interval [CI]: 9.75, 37.5]) and of having ≥2 CCCs was 32 times higher (OR 32.3 [95% CI: 12.9, 50.6]). The AUCs were 0.76 for ≥1 CCC (sensitivity 0.82, specificity 0.80) and 0.74 for ≥2 CCCs (sensitivity 0.92, specificity 0.74). CONCLUSIONS The HOMES accurately identified patients with CCCs.
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Affiliation(s)
- Ingrid A Larson
- Administration (IA Larson), Children's Mercy Hospital Kansas, Overland Park
| | - Isabella Zaniletti
- Analytics, Children's Hospital Association (I Zaniletti and M Hall), Kansas City, Kans
| | - Rupal Gupta
- Department of Pediatrics (R Gupta, SM Wright, C Winterer, C Toburen, K Williams, EJ Goodwin, RM Northup, E Roderick, M Hall, and JD Colvin), Children's Mercy Kansas City, Mo
| | - S Margaret Wright
- Department of Pediatrics (R Gupta, SM Wright, C Winterer, C Toburen, K Williams, EJ Goodwin, RM Northup, E Roderick, M Hall, and JD Colvin), Children's Mercy Kansas City, Mo
| | - Courtney Winterer
- Department of Pediatrics (R Gupta, SM Wright, C Winterer, C Toburen, K Williams, EJ Goodwin, RM Northup, E Roderick, M Hall, and JD Colvin), Children's Mercy Kansas City, Mo
| | - Cristy Toburen
- Department of Pediatrics (R Gupta, SM Wright, C Winterer, C Toburen, K Williams, EJ Goodwin, RM Northup, E Roderick, M Hall, and JD Colvin), Children's Mercy Kansas City, Mo
| | - Kristi Williams
- Department of Pediatrics (R Gupta, SM Wright, C Winterer, C Toburen, K Williams, EJ Goodwin, RM Northup, E Roderick, M Hall, and JD Colvin), Children's Mercy Kansas City, Mo
| | - Emily J Goodwin
- Department of Pediatrics (R Gupta, SM Wright, C Winterer, C Toburen, K Williams, EJ Goodwin, RM Northup, E Roderick, M Hall, and JD Colvin), Children's Mercy Kansas City, Mo
| | - Ryan M Northup
- Department of Pediatrics (R Gupta, SM Wright, C Winterer, C Toburen, K Williams, EJ Goodwin, RM Northup, E Roderick, M Hall, and JD Colvin), Children's Mercy Kansas City, Mo
| | - Edie Roderick
- Department of Pediatrics (R Gupta, SM Wright, C Winterer, C Toburen, K Williams, EJ Goodwin, RM Northup, E Roderick, M Hall, and JD Colvin), Children's Mercy Kansas City, Mo
| | - Matt Hall
- Analytics, Children's Hospital Association (I Zaniletti and M Hall), Kansas City, Kans; Department of Pediatrics (R Gupta, SM Wright, C Winterer, C Toburen, K Williams, EJ Goodwin, RM Northup, E Roderick, M Hall, and JD Colvin), Children's Mercy Kansas City, Mo
| | - Jeffrey D Colvin
- Department of Pediatrics (R Gupta, SM Wright, C Winterer, C Toburen, K Williams, EJ Goodwin, RM Northup, E Roderick, M Hall, and JD Colvin), Children's Mercy Kansas City, Mo.
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Kuo DZ, Lail J, Comeau M, Chesnut E, Meyers A, Mosquera R. Research Agenda for Implementation of Principles of Care for Children and Youth With Special Health Care Needs. Acad Pediatr 2022; 22:S41-S46. [PMID: 35248247 DOI: 10.1016/j.acap.2021.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 06/02/2021] [Accepted: 06/09/2021] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Children and youth with special health care needs (CYSHCN) have a range of medical, educational, and support service needs to achieve optimal health and wellness. Principles of care for CYSHCN have been well described, but the literature is lacking particularly on implementation and integration of care across different settings and systems. The objective of this manuscript is to define a research agenda for principles of care for CYSHCN. METHODS Literature review examined principles of care for CYSHCN. Existing research gaps and priorities for principles of care were drawn from the literature review, a recently developed national research agenda for CYSHCN, and stakeholder consensus. RESULTS Specific implementation areas of inquiry include family partner roles within and across systems; life course approach for CYSHCN; roles and training of interdisciplinary team members; and implementation, spread, and sustainability studies. Proposed methods include implementation science-based and comparative effectiveness research. A common set of metrics including health care utilization, clinical outcomes, and family and provider needs should be considered to evaluate implementation of principles of care. CONCLUSIONS Implementation science and comparative effectiveness methods are needed to further understanding about how to adopt and spread principles of care for CYSHCN. The evolving demographics of CYSHCN add relevance and urgency for research findings.
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Affiliation(s)
- Dennis Z Kuo
- Department of Pediatrics, University at Buffalo (DZ Kuo), Buffalo, NY.
| | | | - Meg Comeau
- Center for Innovation in Social Work & Health, Boston University School of Social Work (M Comeau), Boston, Mass
| | - Emily Chesnut
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center (E Chesnut), Cincinnati, Ohio
| | - Alissa Meyers
- Department of Pediatrics, University of Texas at Houston (A Meyers and R Mosquera), Houston, Tex
| | - Ricardo Mosquera
- Department of Pediatrics, University of Texas at Houston (A Meyers and R Mosquera), Houston, Tex
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Kuo DZ, Comeau M, Perrin JM, Coleman C, White P, Lerner C, Stille CJ. Moving From Spending to Investment: A Research Agenda for Improving Health Care Financing for Children and Youth With Special Health Care Needs. Acad Pediatr 2022; 22:S47-S53. [PMID: 34808384 DOI: 10.1016/j.acap.2021.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/10/2021] [Accepted: 11/14/2021] [Indexed: 12/19/2022]
Abstract
Children and youth with special health care needs (CYSHCN) use disproportionately more health care resources than non-CYSHCN, and their unique needs merit additional consideration. Spending on health care in the United States is heavily concentrated on acute illnesses through fee-for-service (FFS). Payment reform frameworks have focused on shifting away from FFS, addressing health outcomes and the experience of care while lowering costs, particularly for high resource utilizers. The focus of payment reform efforts to date has been on adults with chronic illnesses, with less priority given to investment in children's health and life course. Spending for children's health is also considered an investment in their growth and development with long-term outcomes at stake, so research questions should focus on where and how such spending should be targeted. This paper discusses high-priority research topics in the area of health care financing for CYSHCN in the context of what is currently known and important knowledge gaps related to investment for CYSHCN. It proceeds to describe 3 potential research projects that can address these topics, following a framework informed by the priority questions identified in a previous multistakeholder research agenda development process. We focus on 3 areas: benefits, payment models, and quality measures. Specific aims and hypotheses are offered, as well as suggestions for approaches and thoughts on potential implications.
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Affiliation(s)
- Dennis Z Kuo
- Division of General Pediatrics, Division of Developmental Pediatrics & Rehabilitation, University at Buffalo (DZ Kuo), Buffalo, NY.
| | - Meg Comeau
- Boston University School of Social Work (M Comeau), Boston, Mass
| | - James M Perrin
- MassGeneral Hospital for Children (JM Perrin), Boston, Mass
| | | | - Patience White
- George Washington University School of Medicine and Health Sciences, The National Alliance to Advance Adolescent Health (P White), Washington, DC
| | - Carlos Lerner
- UCLA Mattel Children's Hospital/David Geffen School of Medicine at UCLA (C Lerner), Los Angeles, Calif
| | - Christopher J Stille
- Section of General Academic Pediatrics, University of Colorado School of Medicine (C Stille), Aurora, Colo
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Elango S, Whitmire R, Kim J, Berhane Z, Davis R, Turchi RM. Family Experience of Caregiver Burden and Health Care Usage in a Statewide Medical Home Program. Acad Pediatr 2022; 22:116-124. [PMID: 34280478 DOI: 10.1016/j.acap.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 07/06/2021] [Accepted: 07/10/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVE To evaluate family-reported caregiver experiences and health care utilization of patients enrolled in the Pennsylvania Medical Home Program (PA-MHP) statewide practice network and compare results to PA-MHP practices' Medical Home Index (MHI) scores. We hypothesized families enrolled in higher-scoring patient-and-family-centered medical homes (PCMH) on completed MHIs would report decreased caregiver burden and improved health care utilization. METHODS We analyzed surveys completed by families receiving care coordination services in PA-MHP's network and each practice's mean MHI score. A total of 3221 caregivers completed surveys evaluating hours spent coordinating care/week, missed school/workdays, sick visits, and emergency department (ED) visits. A total of 222 providers from 54 participating PA-MHP practices completed the nationally recognized MHI. Family/practice demographics were collected. We developed multivariate logistic regression models assessing independent associations among family survey outcomes and corresponding practices' MHI scores. RESULTS Families enrolled in high-scoring PCMHs had decreased odds of spending >1 h/wk coordinating care (odds ratio [OR] 0.82, adjusted OR [aOR]: 0.70, 95% confidence interval [CI] 0.55-0.90), missing workdays in the past 6 months (OR 0.82, aOR: 0.72, 95% CI 0.69-0.97), and ED visits in the past 12 months (OR 0.83, aOR: 0.81, 95% CI 0.65-0.99) in comparison to families enrolled in lower-scoring PCMHs. Families enrolled in higher-scoring PCMHs did not report fewer sick visits despite fewer ED visits, indicating more appropriate health care utilization. High-scoring PCMHs had lower percentages of publicly insured and low-income children. CONCLUSIONS Higher-scoring PCMHs are associated with decreased caregiver burden and improved health care utilization across diverse PA practices. Future studies should evaluate interventions uniformly improving PCMH quality and equity.
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Affiliation(s)
- Suratha Elango
- Department of Pediatrics, Baylor College of Medicine (S Elango), Houston, Tex
| | - Rebecca Whitmire
- Department of Pediatrics, St. Christopher's Hospital for Children (R Whitmire and RM Turchi), Philadelphia, Pa; Drexel University, Drexel University College of Medicine (R Whitmire and RM Turchi), Philadelphia, Pa; Drexel University, Dornsife School of Public Health (R Whitmire, J Kim, Z Berhane, R Davis, and RM Turchi), Philadelphia, Pa
| | - John Kim
- Drexel University, Dornsife School of Public Health (R Whitmire, J Kim, Z Berhane, R Davis, and RM Turchi), Philadelphia, Pa
| | - Zekarias Berhane
- Drexel University, Dornsife School of Public Health (R Whitmire, J Kim, Z Berhane, R Davis, and RM Turchi), Philadelphia, Pa
| | - Renee Davis
- Drexel University, Dornsife School of Public Health (R Whitmire, J Kim, Z Berhane, R Davis, and RM Turchi), Philadelphia, Pa
| | - Renee M Turchi
- Department of Pediatrics, St. Christopher's Hospital for Children (R Whitmire and RM Turchi), Philadelphia, Pa; Drexel University, Drexel University College of Medicine (R Whitmire and RM Turchi), Philadelphia, Pa; Drexel University, Dornsife School of Public Health (R Whitmire, J Kim, Z Berhane, R Davis, and RM Turchi), Philadelphia, Pa.
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Brodie N, Bernstein B, McNesby F, Turchi R. The Experience of Latina Mothers of Children and Youth With Special Health Care Needs: A Qualitative Study. Glob Pediatr Health 2019; 6:2333794X19851390. [PMID: 31211182 PMCID: PMC6545643 DOI: 10.1177/2333794x19851390] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 04/23/2019] [Accepted: 04/23/2019] [Indexed: 11/30/2022] Open
Abstract
Children and youth with special health care needs (CYSHCN) comprise a growing proportion of the pediatric population; the patient- and family-centered medical home provides a comprehensive model for caring for these patients. Given the limited literature available as well as extreme patient vulnerability, we sought to understand the experience of Latino parents in caring for their CYSHCN within our patient-centered medical home in an urban neighborhood in North Philadelphia. A convenience sample of 14 mothers or grandmothers of CYSHCN participated in semistructured interviews, which were analyzed using a thematic, constant comparative approach to identify common themes. Themes identified included “Waiting,” “Communication/Trust,” “All-Consuming Requirements of Care/Sacrifice,” and “Fate/Faith/Blessings.” These themes corresponded with identified goals of the patient-centered medical home. Our findings suggest that the principles of the patient-centered medical home can be applied in unique ways to caring for this unique patient population.
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Affiliation(s)
- Nicola Brodie
- St. Christopher's Hospital for Children, Philadelphia, PA, USA.,Drexel University College of Medicine, Philadelphia, PA, USA
| | - Bruce Bernstein
- St. Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Francis McNesby
- St. Christopher's Hospital for Children, Philadelphia, PA, USA.,Drexel University College of Medicine, Philadelphia, PA, USA
| | - Renee Turchi
- St. Christopher's Hospital for Children, Philadelphia, PA, USA.,Drexel University College of Medicine, Philadelphia, PA, USA
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Cordeiro A, Davis RK, Antonelli R, Rosenberg H, Kim J, Berhane Z, Turchi R. Care Coordination for Children and Youth With Special Health Care Needs: National Survey Results. Clin Pediatr (Phila) 2018; 57:1398-1408. [PMID: 29932000 DOI: 10.1177/0009922818783501] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
We analyzed findings from the 2009-2010 National Survey of Children with Special Health Care Needs to identify associations between families with children and youth with special health care needs (CYSHCN) reporting adequate care coordination (CC) with family-provider relations, shared decision making (SDM), and child outcomes. Eligible subjects were the 98% of families asked about CC, service use, and communication. Bivariate analysis using χ2 tests were performed on binary outcome variables to determine the strength of the associations between CC and independent and dependent variables. Weighted, multivariate logistic regression models were constructed to assess independent associations of adequate CC with child outcomes and associations of SDM on adequate CC. Among families of CYSHCN asked about CC, 72% reported receiving help with CC. Of these, 55% reported receiving adequate CC. Family report of adequate CC was favorably associated with family-provider relations, child outcomes, and report of provider participation in SDM.
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Affiliation(s)
| | | | | | | | - John Kim
- 2 Drexel University, Philadelphia, PA, USA
| | | | - Renee Turchi
- 2 Drexel University, Philadelphia, PA, USA.,4 St Christopher's Hospital for Children, Philadelphia, PA, USA
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Feldman HM, Buysse CA, Hubner LM, Huffman LC, Loe IM. Patient Protection and Affordable Care Act of 2010 and children and youth with special health care needs. J Dev Behav Pediatr 2015; 36:207-17. [PMID: 25793891 DOI: 10.1097/DBP.0000000000000151] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Patient Protection and Affordable Care Act (ACA) was designed to (1) decrease the number of uninsured Americans, (2) make health insurance and health care affordable, and (3) improve health outcomes and performance of the health care system. During the design of ACA, children in general and children and youth with special health care needs and disabilities (CYSHCN) were not a priority because before ACA, a higher proportion of children than adults had insurance coverage through private family plans, Medicaid, or the State Children's Health Insurance Programs (CHIP). ACA benefits CYSHCN through provisions designed to make health insurance coverage universal and continuous, affordable, and adequate. Among the limitations of ACA for CYSHCN are the exemption of plans that had been in existence before ACA, lack of national standards for insurance benefits, possible elimination or reductions in funding for CHIP, and limited experience with new delivery models for improving care while reducing costs. Advocacy efforts on behalf of CYSHCN must track implementation of ACA at the federal and the state levels. Systems and payment reforms must emphasize access and quality improvements for CYSHCN over cost savings. Developmental-behavioral pediatrics must be represented at the policy level and in the design of new delivery models to assure high quality and cost-effective care for CYSHCN.
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Abstract
The vast majority of children and youth with chronic and complex health conditions who also have intellectual and developmental disabilities are cared for in their homes. Social, legal, policy, and medical changes through the years have allowed for an increase in needed support within the community. However, there continues to be a relatively small group of children who live in various types of congregate care settings. This clinical report describes these settings and the care and services that are provided in them. The report also discusses reasons families choose out-of-home placement for their children, barriers to placement, and potential effects of this decision on family members. We examine the pediatrician's role in caring for children with severe intellectual and developmental disabilities and complex medical problems in the context of responding to parental inquiries about out-of-home placement and understanding factors affecting these types of decisions. Common medical problems and care issues for children residing outside the family home are reviewed. Variations in state and federal regulations, challenges in understanding local systems, and access to services are also discussed.
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