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dc.contributor.authorAntonelli, Richard C.
dc.contributor.authorStille, Christopher J.
dc.contributor.authorAntonelli, Donna M.
dc.date2022-08-11T08:09:22.000
dc.date.accessioned2022-08-23T16:28:32Z
dc.date.available2022-08-23T16:28:32Z
dc.date.issued2008-07-04
dc.date.submitted2011-12-30
dc.identifier.citationPediatrics. 2008 Jul;122(1):e209-16. <a href="http://dx.doi.org/10.1542/peds.2007-2254">Link to article on publisher's site</a>
dc.identifier.issn0031-4005 (Linking)
dc.identifier.doi10.1542/peds.2007-2254
dc.identifier.pmid18595966
dc.identifier.urihttp://hdl.handle.net/20.500.14038/37040
dc.description.abstractOBJECTIVES: Objectives included testing use of the care-coordination measurement tool in pediatric primary care practices; describing care-coordination activities for children and youth that occur in primary care practices; assessing the relationship of care-coordination activities in the medical home with outcomes related to resource use; and measuring the direct personnel costs of care-coordination activities. METHODS: Six general pediatric practices were selected, representing a diverse range of sizes, locations, patient demographics, and care-coordination activity model types. The care-coordination measurement tool was used over a period of 8 months in 2003 to record all of the nonreimbursable care-coordination activity encounters performed by any office-based personnel. The tool enabled recording of activities, resources-use outcomes, and time. Cost of personnel performing care-coordination activities was derived by extrapolation from the time spent. RESULTS: Care-coordination activity services were used by patients of all complexity levels. Children and youth with special health care needs with acute-onset, family-based psychosocial problems experienced 14% of the care-coordination activity encounters and used 21% of the care-coordination activities minutes. Children and youth without special health care needs, without complicating family psychosocial problems, received 50% of the encounters and used 36% of the care-coordination activity minutes. The average cost per care-coordination activity encounter varied from $4.39 to $12.86, with an overall mean of $7.78. A principal cost driver seemed to be the percentage of care-coordination activities performed by physicians. Office-based nurses prevented a large majority of emergency department visits and episodic office visits. CONCLUSIONS: Care-coordination activity was assessed at the practice level, and the care-coordination measurement tool was used successfully during the operations of typical, pediatric, primary care settings. The presence of acute, family-based social stressors was a significant driver of need for care-coordination activities. A high proportion of dependence on care-coordination performed by physicians led to increased costs. Office-based nurses providing care coordination were responsible for a significant number of episodes of avoidance of higher cost use outcomes.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=18595966&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1542/peds.2007-2254
dc.subjectAllied Health Personnel
dc.subjectChild
dc.subject*Child, Exceptional
dc.subject*Disabled Children
dc.subjectHealth Services Needs and Demand
dc.subjectHumans
dc.subjectPatient Care Planning
dc.subjectPediatrics
dc.subjectPrimary Health Care
dc.subjectUnited States
dc.subjectHealth Services Research
dc.subjectPediatrics
dc.subjectPrimary Care
dc.titleCare coordination for children and youth with special health care needs: a descriptive, multisite study of activities, personnel costs, and outcomes
dc.typeJournal Article
dc.source.journaltitlePediatrics
dc.source.volume122
dc.source.issue1
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/meyers_pp/426
dc.identifier.contextkey2426082
html.description.abstract<p>OBJECTIVES: Objectives included testing use of the care-coordination measurement tool in pediatric primary care practices; describing care-coordination activities for children and youth that occur in primary care practices; assessing the relationship of care-coordination activities in the medical home with outcomes related to resource use; and measuring the direct personnel costs of care-coordination activities.</p> <p>METHODS: Six general pediatric practices were selected, representing a diverse range of sizes, locations, patient demographics, and care-coordination activity model types. The care-coordination measurement tool was used over a period of 8 months in 2003 to record all of the nonreimbursable care-coordination activity encounters performed by any office-based personnel. The tool enabled recording of activities, resources-use outcomes, and time. Cost of personnel performing care-coordination activities was derived by extrapolation from the time spent.</p> <p>RESULTS: Care-coordination activity services were used by patients of all complexity levels. Children and youth with special health care needs with acute-onset, family-based psychosocial problems experienced 14% of the care-coordination activity encounters and used 21% of the care-coordination activities minutes. Children and youth without special health care needs, without complicating family psychosocial problems, received 50% of the encounters and used 36% of the care-coordination activity minutes. The average cost per care-coordination activity encounter varied from $4.39 to $12.86, with an overall mean of $7.78. A principal cost driver seemed to be the percentage of care-coordination activities performed by physicians. Office-based nurses prevented a large majority of emergency department visits and episodic office visits.</p> <p>CONCLUSIONS: Care-coordination activity was assessed at the practice level, and the care-coordination measurement tool was used successfully during the operations of typical, pediatric, primary care settings. The presence of acute, family-based social stressors was a significant driver of need for care-coordination activities. A high proportion of dependence on care-coordination performed by physicians led to increased costs. Office-based nurses providing care coordination were responsible for a significant number of episodes of avoidance of higher cost use outcomes.</p>
dc.identifier.submissionpathmeyers_pp/426
dc.contributor.departmentMeyers Primary Care Institute
dc.contributor.departmentDepartment of Pediatrics
dc.source.pagese209-16


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