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Care coordination for children and youth with special health care needs: a descriptive, multisite study of activities, personnel costs, and outcomes.
Pediatrics. 2008 Jul; 122(1):e209-16.Ped

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.

Authors+Show Affiliations

Division of Academic General Pediatrics, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, Connecticut 06106, USA. rantonelli@ccmckids.orgNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

18595966

Citation

Antonelli, Richard C., et al. "Care Coordination for Children and Youth With Special Health Care Needs: a Descriptive, Multisite Study of Activities, Personnel Costs, and Outcomes." Pediatrics, vol. 122, no. 1, 2008, pp. e209-16.
Antonelli RC, Stille CJ, Antonelli DM. Care coordination for children and youth with special health care needs: a descriptive, multisite study of activities, personnel costs, and outcomes. Pediatrics. 2008;122(1):e209-16.
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), e209-16. https://doi.org/10.1542/peds.2007-2254
Antonelli RC, Stille CJ, Antonelli DM. Care Coordination for Children and Youth With Special Health Care Needs: a Descriptive, Multisite Study of Activities, Personnel Costs, and Outcomes. Pediatrics. 2008;122(1):e209-16. PubMed PMID: 18595966.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Care coordination for children and youth with special health care needs: a descriptive, multisite study of activities, personnel costs, and outcomes. AU - Antonelli,Richard C, AU - Stille,Christopher J, AU - Antonelli,Donna M, PY - 2008/7/4/pubmed PY - 2008/8/1/medline PY - 2008/7/4/entrez SP - e209 EP - 16 JF - Pediatrics JO - Pediatrics VL - 122 IS - 1 N2 - 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. SN - 1098-4275 UR - https://www.unboundmedicine.com/medline/citation/18595966/Care_coordination_for_children_and_youth_with_special_health_care_needs:_a_descriptive_multisite_study_of_activities_personnel_costs_and_outcomes_ L2 - http://pediatrics.aappublications.org/cgi/pmidlookup?view=long&pmid=18595966 DB - PRIME DP - Unbound Medicine ER -