Care coordination for children and youth with special health care needs: a descriptive, multisite study of activities, personnel costs, and outcomes
dc.contributor.author | Antonelli, Richard C. | |
dc.contributor.author | Stille, Christopher J. | |
dc.contributor.author | Antonelli, Donna M. | |
dc.date | 2022-08-11T08:09:22.000 | |
dc.date.accessioned | 2022-08-23T16:28:32Z | |
dc.date.available | 2022-08-23T16:28:32Z | |
dc.date.issued | 2008-07-04 | |
dc.date.submitted | 2011-12-30 | |
dc.identifier.citation | Pediatrics. 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.issn | 0031-4005 (Linking) | |
dc.identifier.doi | 10.1542/peds.2007-2254 | |
dc.identifier.pmid | 18595966 | |
dc.identifier.uri | http://hdl.handle.net/20.500.14038/37040 | |
dc.description.abstract | 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. 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.iso | en_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.url | http://dx.doi.org/10.1542/peds.2007-2254 | |
dc.subject | Allied Health Personnel | |
dc.subject | Child | |
dc.subject | *Child, Exceptional | |
dc.subject | *Disabled Children | |
dc.subject | Health Services Needs and Demand | |
dc.subject | Humans | |
dc.subject | Patient Care Planning | |
dc.subject | Pediatrics | |
dc.subject | Primary Health Care | |
dc.subject | United States | |
dc.subject | Health Services Research | |
dc.subject | Pediatrics | |
dc.subject | Primary Care | |
dc.title | Care coordination for children and youth with special health care needs: a descriptive, multisite study of activities, personnel costs, and outcomes | |
dc.type | Journal Article | |
dc.source.journaltitle | Pediatrics | |
dc.source.volume | 122 | |
dc.source.issue | 1 | |
dc.identifier.legacycoverpage | https://escholarship.umassmed.edu/meyers_pp/426 | |
dc.identifier.contextkey | 2426082 | |
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.submissionpath | meyers_pp/426 | |
dc.contributor.department | Meyers Primary Care Institute | |
dc.contributor.department | Department of Pediatrics | |
dc.source.pages | e209-16 |