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Association of Care Coordination Experience and Health Services Use with Main Provider Type for Children with
Neal A deJong1, Marie Wofford2, Paula H Song3
1Division of General Pediatrics and Adolescent Medicine, UNC School of Medicine, Chapel Hill, NC.
Insights
Families of children with inflammatory bowel disease (IBD) may face care coordination trade-offs. Identifying a primary care physician (PCP) as the main provider increased use of primary and mental health services but may impact IBD care coordination.
Area of Science:
- Pediatric gastroenterology
- Health services research
- Care coordination
Background:
- Children with inflammatory bowel disease (IBD) require coordinated care across multiple specialists.
- The perceived main provider (primary care physician vs. gastroenterologist) may influence care coordination and health service utilization.
- Understanding these differences is crucial for optimizing care for pediatric IBD patients.
Purpose of the Study:
- To describe the care coordination experience for families of children with IBD.
- To compare health service utilization between families who identified a primary care physician (PCP) or a gastroenterologist as the child's main provider.
Main Methods:
- Cross-sectional survey of 101 children (aged 6-19) with IBD and their parents.
- Assessed care coordination experiences and past-year health services use.
- Used bivariate testing and logistic regression to compare outcomes based on main provider identification, adjusting for covariates.
Main Results:
- 41% of families identified a PCP as the main provider.
- Gastroenterologist as main provider showed higher performance on some care coordination indicators.
- PCP as main provider was associated with increased use of primary care and mental health services when needed.
- No difference in IBD-related hospitalizations or emergency department visits between groups.
Conclusions:
- Care coordination quality and access to non-disease-specific services may differ based on the perceived main provider for children with IBD.
- Enhanced coordination between primary care, specialty care, and families is needed to improve overall care quality for pediatric IBD patients.
Objectives:
To describe care coordination experience for families of children with inflammatory bowel disease (IBD) and compare use of health services between families who identified a primary care physician (PCP) vs a gastroenterologist as a child's main provider.
Study Design:
This is a cross-sectional survey of care coordination experiences and health services use for children 6-19 years old receiving care in the IBD program at a children's hospital during 2018. English-speaking parents completed the Family Experiences with Coordination of Care Survey about their child's main provider and reported past-year health services. Bivariate testing and multivariate logistic regression explored differences in care coordination experience and health services by main provider, adjusted for demographic and clinical variables.
Results:
A total of 113 of 270 (42%) invited patients participated. Among 101 patients with complete data, 41% identified a PCP main provider. Performance on 5 of 16 Family Experiences with Coordination of Care indicators was higher for patients reporting a gastroenterologist vs a PCP main provider. However, having a PCP vs gastroenterologist main provider was associated with greater use of any past-year primary care services (adjusted proportion 94% vs 75%; P = .01) and of mental health services when needed (95% vs 60%; P < .01). Need for IBD-related hospitalization and emergency department visits did not differ between groups.
Conclusions:
Children with IBD may experience trade-offs in care coordination quality and important, non-disease-focused health services based on whom parents perceive as the main provider. Efforts to enhance cross-team coordination among families and primary and specialty care teams are needed to improve overall care quality.
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