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Consultative Care Coordination Through the Medical Home for CSHCN: A Randomized Controlled Trial

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Abstract

The purpose of this study was to examine the impact of a care coordination intervention aimed at improving the medical home for children with special health care needs (CSHCN). 100 CSHCN referred by a Medicaid managed care plan were randomly assigned to a care coordination intervention or to a wait list comparison group that received standard care. For the intervention group, a care coordinator supported the medical home by consulting with primary care providers at multiple practices to develop an integrated, individualized plan to meet child and family needs. During the second phase of the study, the wait list comparison group received the 6-month intervention. At the end of 12 months, the two groups were combined to examine within subject differences (n = 61). Compared to the control group, participants in the initial intervention group reported a decreased need for information and improved satisfaction with mental health services and specialized therapies. This effect was replicated when the wait list control group received the intervention. Additional benefits were observed in the within subject analysis, including a decline in unmet needs, improved satisfaction with specialty care and care coordination, and improved ratings of child health and family functioning. This intervention improved outcomes for CSHCN and their families by supporting the efforts of primary care physicians to provide comprehensive and coordinated care through the medical home. The consulting care coordinator may provide an efficient and cost effective approach to enhancing the quality of care for CSHCN.

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Abbreviations

CSHCN:

Children with special health care needs

ICD-9-CM:

International Classification of Disease, 9th Revision, Clinical Modification

FSS:

Family Support Specialist

FNS:

Family Needs Survey

IFS:

Impact on Family Scale

FS II [R]:

Functional Status II (Revised)

FS:

Family Support scale

SD:

Standard deviation

References

  1. US Department of Health and Human Services. (2000). Healthy people 2010: Understanding and improving health (2nd ed.). Washington, D.C: U.S. Government Printing Office.

    Google Scholar 

  2. Antonelli, R. C., McAllister, J. W., & Popp, J. (2009). Making care coordination a critical component of the pediatric health system: A multidisciplinary framework. [updated 2009; cited 2009 December 12], 1–26 Available from: commonwealthfund.org.

  3. Perrin, J. M., Romm, D., Bloom, S. R., Homer, C. J., Kuhlthau, K. A., Cooley, C., et al. (2007). A family-centered, community-based system of services for children and youth with special health care needs. Archives of Pediatr Adolescence, 161(10), 933–936.

    Article  Google Scholar 

  4. McAllister, J. W., Presler, E., & Cooley, W. C. (2007). Practice-based care coordination: A medical home essential. Pediatrics, 120(3), e723–e733.

    Article  PubMed  Google Scholar 

  5. Kogan, M. D., Strickland, B. B., & Newacheck, P. W. (2009). Building systems of care: Findings from the national survey of children with special health care needs. Pediatrics 2009 Supplement December, 124, S333–S336.

    Google Scholar 

  6. Warfield, M. E., & Gulley, S. (2006). Unmet need and problems accessing specialty medical and related services among children with special health care needs. Maternal and Child Health Journal, 10(2), 201–216.

    Article  PubMed  Google Scholar 

  7. Strickland, B., McPherson, M., Weissman, G., van Dyke, P., Huang, Z. J., & Newacheck, P. W. (2004). Access to the medical home: Results of the national survey of children with special health care needs. Pediatrics, 113(5), 1485–1492.

    PubMed  Google Scholar 

  8. Gupta, V. B., O’Connor, K. G., & Quezada-Gomez, C. (2004). Care coordination services in pediatric practices. Pediatrics, 113(5), 1517–1521.

    PubMed  Google Scholar 

  9. Homer, C. J., Klatka, K., Tomm, D., Kuhlthau, K., Bloom, S. R., Newacheck, P. W., et al. (2008). A review of the evidence for the medical home for children with special health care needs. Pediatrics, 122(4, October), e922–e937.

    Article  PubMed  Google Scholar 

  10. Antonelli, R. C., Stille, C. J., & Antonelli, D. M. (2008). Care coordination for children and youth with special health care needs: A descriptive, multisite study of activities, personnel costs, and outcomes. Pediatrics, 122(1), e209–e216.

    Article  PubMed  Google Scholar 

  11. Wood, D. L., Winterbauer, N., Sloyer, P., Jobli, E., Hou, T., McCaskill, Q. E., et al. (2009). A longitudinal study of a pediatric practice-based versus an agency based model of care coordination for child and youth with special health care needs. Maternal and Child Health Journal, 13(5), 667–676.

    Article  PubMed  Google Scholar 

  12. Farmer, J. E., Clark, M. J., Sherman, A., Marien, W. E., & Selva, T. J. (2005). Comprehensive primary care for children with special health care needs in rural areas. Pediatrics, 116, 649–656.

    Article  PubMed  Google Scholar 

  13. Bethell, C. D., Read, D., Stein, R. E. K., Blumberg, S. J., Wells, N., & Newacheck, P. W. (2002). Identifying children with special health care needs: development and evaluation of a short screening instrument. Ambulatory Pediatrics, 2, 49–57.

    Article  PubMed  Google Scholar 

  14. Palfrey, J. S., Sofis, L. A., Davidson, E. J., Liu, J., Freeman, L., & Ganz, M. L. (2004). The Pediatric alliance for coordinated care: Evaluation of a medical home model. Pediatrics, 113, 1507–1516.

    PubMed  Google Scholar 

  15. Drotar, D. (2001). Promoting comprehensive care for children with chronic health conditions and their families: Introduction to the special issue. Children’s Services: Social Policy, Research, and Practice, 4, 157–163.

    Google Scholar 

  16. Jessop, D. J., & Stein, R. E. K. (1994). Providing comprehensive health care to children with chronic illness. Pediatrics, 93(4), 602–607.

    PubMed  CAS  Google Scholar 

  17. King, G., King, S., Rosenbaum, P., & Goffin, R. (1999). Family-centered caregiving and well-being of parents of children with disabilities: Linking process with outcome. Journal of Pediatric Psychology, 24, 41–53.

    Article  Google Scholar 

  18. Ganz, M. L., & Tendulkar, S. A. (2006). Mental health care services for children with special health care needs and their family members: Prevalence and correlates of unmet needs. Pediatrics, 117(6), 2138–2148.

    Article  PubMed  Google Scholar 

  19. Kazak, A. E., Rourke, M. T., & Navsaria, N. (2009). Families and other systems in pediatric psychology. In M. C. Roberts, & R. Steele (Eds.), Handbook of pediatric psychology (4th ed., pp. 571–656). New York: Guilford Press.

    Google Scholar 

  20. Epstein, S. G., Taylor, A. B., Halberg, A. S., Gardner, J. D., Walker, D. K., & Crocker, A. C. (1998). Shared responsibilities: Ensuring quality managed care for children with special health care needs. Took kit: Version 1.0. Boston, MA: New England SERVE.

    Google Scholar 

  21. Dunst, C. J., Trivette, C. M., & Hamby, D. W. (1994). Measuring social support in families with young children with disabilities. In C. J. Dunst, C. M. Trivette, & A. J. Deal (Eds.), Supporting and strengthening families: Methods, strategies, and practices. Cambridge, MA: Brookline Books.

    Google Scholar 

  22. Bailey, D. B., & Simeonsson, R. J. (1988). Assessing needs of families with handicapped infants. Journal of Special Education, 22, 117–126.

    Article  Google Scholar 

  23. Stein, R. E. K., & Riessman, C. K. (1980). The development of an Impact-on-Family Scale: Preliminary findings. Medical Care, 18, 465–472.

    Article  PubMed  CAS  Google Scholar 

  24. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the beck depression inventory (2nd ed.). Antonio, TX: The Psychological Corporation.

    Google Scholar 

  25. Stein, R. E. K., & Jessop, D. J. (1990). Functional Status II (R): A measure of child health status. Medical Care, 28, 1041–1055.

    Article  PubMed  CAS  Google Scholar 

  26. Pediatric Alliance for Coordinated Care Project. (1998). The pediatric alliance for coordinated care family survey—Your care experience. Boston, MA: Children’s Hospital Corporation.

  27. Medicode. (2000). 2001 physician international classification of diseases, ninth revision, clinical modification (6th ed.). Salt Lake City: Medicode.

    Google Scholar 

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Acknowledgments

This research was supported by a grant from the Missouri Foundation for Health (Grant # 02-0020-03) and Missouri Care Health Plan. We also extend our thanks to the primary care practices and families who so generously gave of their time to make this research possible.

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Author notes

  1. Janet E. Farmer

    Present address: Department of Health Psychology, University of Missouri, 205 Portland Street, Columbia, MO, 65211, USA

  2. Mary J. Clark

    Present address: Thompson Center for Autism and Neurodevelopmental Disorders, University of Missouri, Columbia, MO, USA

  3. Elena Harlan Drewel

    Present address: Department of Health Psychology, University of Missouri, Columbia, MO, USA

  4. Theresa M. Swenson

    Present address: Department of Child Health, University of Missouri, Columbia, MO, USA

Authors and Affiliations

  1. Department of Health Psychology, University of Missouri, Columbia, MO, USA

    Janet E. Farmer, Mary J. Clark & Theresa M. Swenson

  2. Department of Psychological Sciences, University of Missouri, Columbia, MO, USA

    Elena Harlan Drewel

  3. Office of Medical Research, University of Missouri, Columbia, MO, USA

    Bin Ge

Authors
  1. Janet E. Farmer
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  2. Mary J. Clark
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  3. Elena Harlan Drewel
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  4. Theresa M. Swenson
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  5. Bin Ge
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Correspondence to Janet E. Farmer.

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Farmer, J.E., Clark, M.J., Drewel, E.H. et al. Consultative Care Coordination Through the Medical Home for CSHCN: A Randomized Controlled Trial. Matern Child Health J 15, 1110–1118 (2011). https://doi.org/10.1007/s10995-010-0658-8

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