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Care coordination for children with special health care needs: a cohort study
Elisa Zanello1, Simona Calugi1, Lee M Sanders2
1Department of Biomedical and Neuromotor Sciences, Division of Hygiene and Biostatistics, Alma Mater Studiorum University of Bologna, Via San Giacomo 12, Bologna, 40126, Italy.
Insights
Family Pediatricians (FPs) can effectively coordinate care for children with special health care needs. Their activities, including specialist contact, help prevent inappropriate service use and hospitalizations.
Area of Science:
- Pediatrics
- Healthcare Management
- Health Services Research
Background:
- Care coordination is vital for patients with chronic conditions.
- Family Pediatricians (FPs) are central to coordinating care for children with special health care needs.
- This study evaluates FP care coordination activities in pediatric primary care.
Purpose of the Study:
- To evaluate the care coordination activities of Family Pediatricians (FPs) for children with special health care needs.
- To assess the effectiveness of these activities in preventing inappropriate service use.
- To utilize an online measurement tool for data collection.
Main Methods:
- Prospective cohort study (SpeNK) involving newborns and children with special health care needs.
- FPs completed a questionnaire (SpeNK-FP) adapted from the Care Coordination Measurement Tool (CCMT©) during patient encounters over a 9-month period.
- The study focused on the Italian organizational context and measured inappropriate service use.
Main Results:
- Forty FPs assessed 49 children across 382 encounters.
- FPs reported "no need for care coordination" in 50.8% of encounters.
- Pediatric-specialist contact was associated with reduced odds of preventable hospitalization (OR=0.06, p=0.005).
Conclusions:
- Family Pediatricians in Italy demonstrate potential as effective care coordinators.
- FP care coordination can facilitate integrated care pathways for children with special health care needs.
- The findings support the role of FPs in optimizing healthcare delivery for this population.
Background:
Care coordination is widely recognized as a key element of care for patients with chronic and complex medical conditions and their families. In care for children with special health care needs the Family Pediatrician (FP) plays a central role as care coordinator. This study aims to evaluate the FPs' activities of care coordination for children with special health care needs in the pediatric primary care setting, using an on-line measurement tool.
Methods:
Within the prospective cohort study SpeNK (Special Needs Kids), newborns and children with special health care needs were recruited at discharge from three hospital facilities in Bologna province, from October 1st 2012 to September 30th 2014. Their FPs were invited to complete a questionnaire (SpeNK-FP) at each encounter for the patient during a 9-month period after hospital discharge. SpeNK-FP was developed by adapting the Care Coordination Measurement Tool (CCMT©) developed by Antonelli et al., to the Italian organizational context. The outcome of interest, derived from the questionnaire, is inappropriate use of services.
Results:
Forty FPs completed assessments for 49 children at each of 382 clinical encounters. The majority of children (71.4%) had special health care needs, without complicating social issues. FPs reported "no need for care coordination" in 50.8% of the encounters and 41.1% of records about patient needs requiring care coordination. The most common activity implemented to meet children's needs was telephone contact with a medical provider. According to FPs, 80% of encounters prevented inappropriate services use. In multivariate regression, pediatric-specialist contact (telephone or in person) was associated with reduced odds of physician report of preventable hospitalization (OR = 0.06, 95% CI 0.01-0.42, p = 0.005).
Conclusions:
The study shows the potential for FPs in Italy to serve as care coordinators and facilitate the implementation of integrated care pathways for children with special health care needs.
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