Care Coordination Services Research Articles

Validation of New Care Coordination Quality Measures for Children with Medical Complexity

ObjectivesTo validate new caregiver-reported quality measures assessing care coordination services for children with medical complexity (CMC). MethodsA cross-sectional analysis of the associations between 20 newly developed Family Experiences with Coordination of Care (FECC) quality measures and 3 validation measures among 1209 caregivers who responded to a telephone or mailed survey from August to November 2013 in Minnesota and Washington. Validation measures included an access composite, a provider rating item, and a care coordination outcome measure, all derived from Consumer Assessments of Healthcare Providers and Systems (CAHPS) survey items. Multivariate regression was used to examine associations between the 3 validation measures and each of the 20 FECC quality measures. ResultsNineteen of the 20 FECC quality measures were significantly and positively associated with ≥1 of the validation measures. The components of care coordination demonstrating the strongest positive association with provider ratings included: 1) having a care coordinator who was knowledgeable and supportive and advocated for the child's needs (β = 26.4; 95% confidence interval [CI], 20.0–32.8, scaled to reflect change associated with a 0-100 change in the FECC measure score); and 2) receiving a written visit summary that was useful and easy to understand (β = 22.0; 95% CI, 17.1–27.0). ConclusionsNineteen newly developed FECC quality measures demonstrated convergent validity with previously validated CAHPS measures. These new measures are valid for assessing the quality of care coordination services provided to CMC and may be useful for evaluating new models of care focused on improving these services.

Less time in Hospital; more time at home

Introduction: Navigating the maze of the health system can be challenging for families of children with chronic and complex conditions. These children often slip through the gaps, are managed by multiple teams and become disengaged with primary and local services. The Sydney Children’s Hospitals Network (SCHN) Care Coordination Service helps care teams partner with families and local health services so that children with chronic and complex conditions spend less time in hospital and more time at home. Practice change implemented (methodology): The SCHN Care Coordination program (Kids GPS – Guided Personalised Services) applies a quality improvement framework using ‘Plan, Do, Study, Act’ (PDSA) cycles to continually implement, evaluate and modify approaches to care coordination. The service consists of nurses and social workers – ‘the Care Coordinators’ who work in partnership with the hospital, community and family ‘lead’ to develop a contemporaneous care plan. A strategy of combining ambulatory models of care and a 24/7 telephone service has made this program more robust. The program was implemented in February 2014. Outcomes are measured on a monthly basis with data comparison driving further PDSA cycles. Aim / targeted population: To implement a model of care coordination for children with medical complexity that aims to improve efficiency and patient outcomes by supporting families to navigate services/providers within SCHN, Local Health Districts (LHDs) and Primary Health Networks (PHNs). Care Coordination for this cohort of children intends to reduce avoidable hospital attendance and improve the integration of care between community health providers and the hospital. Highlights (outcomes): Kids GPS has achieved significant outcomes measured both in terms of hospital encounters saved and patient-focussed outcomes. The program currently has 446 children enrolled. Between July 2015 and June 2017, the service demonstrated: 875 hospital encounters saved, equating to approximately $977,000 in financial savings for SCHN 51,500 KM travel saved for families and 370 school absences prevented 204 ED presentations avoided, with implementation of a 24/7 Hotline in August 2016 increasing the average ED presentations saved per month from 1.6 to 16.7 Analysis of the past six months data (Jan-Jun 2017) demonstrates a 400% increase in encounters saved (448 compared to 111 between Jul-Dec 2016) following service design changes though various PDSA cycles. Sustainability and transferability: Members of the SCHN Care Coordination team are part of the Children’s Healthcare Australasia (CHA) Complex Care Special Interest Group. The networking from this group has resulted in referrals of complex patients moving interstate, enabling care coordination to commence prior to the patient relocating. This has proven an innovative way of inter-state agency collaboration. It is anticipated that future funding will lead to additional care coordinators with a focus on aboriginal patients/families, and children/youth presenting frequently to the ED for mental health or behavioural disorders. Conclusion: Effective care coordination can significantly benefit the lives of patients/families with chronic and complex conditions. Key lessons learned: Combining ambulatory models of care with care coordination makes the integrated model of care more robust 24/7 hotline access providesa further safety net to empower parents/carers Outcome measurements that are patient focussed helps to create organisational cultural change

Care coordination for older people in England: Does context shape approach?

Summary Policy and practice developments in adult social care in England and elsewhere recognise the increasing role of the non-statutory sector. Care coordination services are central to the delivery of tailored support. This qualitative study focuses on support for older people and reports an analysis of 13 non-statutory sector services providing care coordination, grouped into four service types. Semi-structured interviews explored the influence of service context on the nature of practice. Findings Particular elements of care coordination (e.g. assessment) were found to be shaped by the specific aims and purpose of each service type, such as extent to which they had a commissioning or provider role and the nature of their target group. Aspects of a range of case and care management approaches were in use throughout the sample, varying in relation to the distinct features of the service type. A set of overarching standards was found to be relevant to all services considered. Non-statutory sector services were found to provide innovative support which both complemented and sometimes substituted for the statutory sector. Applications Findings point to the continued importance of social work values and methods to the work of non-statutory sector services providing care coordination and to current limitations in relation to what the sector can provide. These are issues which employers and service commissioners need to address to ensure that non-statutory sector services have the capacity and standards of practice to meet the demands made of them. Further areas of research are identified.

Models of Care Delivery for Children With Medical Complexity.

Children with medical complexity (CMC) are a subset of children and youth with special health care needs with high resource use and health care costs. Novel care delivery models in which care coordination and other services to CMC are provided are a focus of national and local health care and policy initiatives. Current models of care for CMC can be grouped into 3 main categories: (1) primary care-centered models, (2) consultative- or comanagement-centered models, and (3) episode-based models. Each model has unique advantages and disadvantages. Evaluations of these models have demonstrated positive outcomes, but most studies have limited generalizability for broader populations of CMC. A lack of standardized outcomes and population definitions for CMC hinders assessment of the comparative effectiveness of different models of care and identification of which components of the models lead to positive outcomes. Ongoing challenges include inadequate support for family caregivers and threats to the sustainability of models of care. Collaboration among key stakeholders (patients, families, providers, payers, and policy makers) is needed to address the gaps in care and create best practice guidelines to ensure the delivery of high-value care for CMC.

Medical Assistance in Dying in Alberta: Implementation of a Provincial Care Coordination Service for an Unprecedented Clinical Activity

Medical Assistance in Dying in Alberta: Implementation of a Provincial Care Coordination Service for an Unprecedented Clinical Activity

The Hidden Roles That Management Partners Play In Accountable Care Organizations.

Accountable care organizations (ACOs) are often discussed and promoted as driven by physicians, hospitals, and other health care providers. However, because of the flexible nature of ACO contracts, management organizations may also become partners in ACOs. We used data from 2013-15 on 276 ACOs from the National Survey of Accountable Care Organizations to understand the prevalence of nonprovider management partners' involvement in ACOs, the services these partners provide, and the structure of ACOs that have such partners. We found that 37percent of ACOs reported having a management partner, and two-thirds of these ACOs reported that the partner shared in the financial risks or rewards. Among ACOs with partners, 94percent had data services provided by the partner, 87percent received administrative services, 68percent received educational services, and 66percent received care coordination services. Half received all four of these services from their partner. ACOs with partners were more heavily primary care than other ACOs. ACOs with and without partners had similar performance on costs and quality in Medicare ACO programs. Our findings suggest that management partners play a central role in many ACOs, perhaps supplying smaller and physician-run ACOs with services or expertise perceived as necessary for ACO success.

Consumer-provider relationships in a care coordination model of service: consumer perspectives

ABSTRACTObjective: The aim of this study was to identify aspects of the consumer-provider relationship that consumers saw as important in a care coordination service model.Method: Semi-structured interviews were conducted, between October 2015 and March 2016, with 20 people living with severe and persistent mental illness who used a care coordination service in Sydney, Australia. Data were analysed using constant comparative analysis.Results: Participants described five specific aspects of the consumer-provider relationship that they deemed important within their care coordination service experience: rapport and listening; an individualised approach; collaboration and partnership; reliability; and genuine care and respect. These were not independent, but rather, interdependent elements that collectively described a ‘good’ consumer-provider relationship.Discussion: While previous literature has examined the consumer-provider relationship in high-intensity and therapeutic models of service, this study confirms that similar relationship features are important in low-intensity or brokerage type models. Aspects such as the provider being easy to talk to and reliable appear to be of additional importance in this particular model. Findings suggest that the ability to develop trusting and collaborative relationships within a short timeframe is a critical consideration for recruitment and training of service providers working within care coordination models of service.

Practitioners preferences of care coordination for older people: A discrete choice experiment

ABSTRACTThese findings demonstrate the importance of organisations providing care coordination for older people receiving long-term funding. Further research is required to investigate the influence of service setting on practitioner preferences.This study explored practitioner preferences about the relative value of attributes of care coordination services for older people. A Discrete Choice Experiment (DCE) survey was used to identify the views of 120 practitioners from 17 services in England in 2015. The survey design was informed by an analysis of standards of care coordination, a postal survey and a consultation with carers of older people. Results of the DCE survey were supplemented by a content analysis of qualitative comments and fieldwork notes. Most respondents were over 30 years of age, female and almost half worked part-time. Continuity of care (care provided by the same care coordinator) and the ability to access the range of services outlined in the care plan were the most important service attributes. Service setting influenced practitioner preferences. Those in specialist services for people with dementia identified the length of time a service was provided as another important attribute. The DCE methodology has provided the opportunity to systematically canvas practitioner preferences.

Improving Outcomes After Hospitalization: A Prospective Observational Multicenter Evaluation of Care Coordination Strategies for Reducing 30-Day Readmissions to Maryland Hospitals.

Patients frequently experience suboptimal transitions from the hospital to the community, which can increase the likelihood of readmission. It is not known which care coordination services can lead to improvements in readmission rates. To evaluate the effects of two care coordination interventions on 30-day readmission rates. Prospective multicenter observational study of hospitalized patients eligible for two care coordination services between January 1, 2013, and October 31, 2015. Readmission rates were compared for patients who received each care coordination intervention versus those who did not using multivariable generalized estimating equation logistic regression models. A total of 25,628 patients hospitalized in medicine, neurosciences, or surgical sciences units. Patients discharged home and deemed to be at high risk for readmission were assigned a nurse Transition Guide (TG) for 30 days post-discharge. All other patients were assigned the Patient Access Line (PAL) intervention, which provided a post-discharge phone call from a registered nurse. Two large academic hospitals in Baltimore, MD. Thirty-day all-cause readmission to any Maryland hospital. Among all patients, 14.2% (2409/16,993) of those referred for the PAL intervention and 22.8% (1973/8635) of those referred for the TG intervention were readmitted. PAL-referred patients who did not receive the intervention had an adjusted odds ratio (aOR) for readmission of 1.27 (95% confidence interval [95% CI] 1.12-1.44, p<0.001) compared with patients who did. TG-referred patients who did not receive the TG intervention had an aOR of 1.83 (95% CI 1.60-2.10, p<0.001) compared with patients who received the intervention. Younger age, male sex, having more comorbidities, and being discharged from a medicine unit were associated with not receiving an assigned intervention. These characteristics were also associated with higher readmission rates. PAL and TG care coordination interventions were associated with lower rates of 30-day readmission. Our findings underscore the importance of determining the appropriate intervention for the hardest-to-reach patients, who are also at the highest risk of being readmitted.

Engaging Primary Care Providers to Participate in a Telephonic Consultation System to Improve Pediatric Behavioral Health Access

Introduction: Access to pediatric behavioral health services has been a longstanding problem in the United States. Resources are scarcest for children in rural areas with publicly funded health insurance. One solution is integrating behavioral health services into pediatric medical settings, but this requires substantial resources and faces a host of financial barriers.(1) Practice Change & Aim: In response, telephonic consultation services have been developed where a centralized behavioral health team advises numerous primary care (PC) offices across a large geographic area.(2, 3) Engagement of PC offices is critical to the success of these programs, but little is known about factors that predict successful engagement. Targeted Population and Timeline: We report on the initial experiences in establishing a telephonic psychiatry consult service (TiPS) for children with publicly funded health insurance across Pennsylvania. TiPS consists of three regional teams composed of a child psychiatrist, therapist and care coordinator, each providing services to a region including 400,000 youth with Medicaid. The central region is predominantly rural and been designated as a severe shortage area (4) where 50% of the counties have no child psychiatrists. The program started in the summer of 2016, with initial efforts focused on engaging high volume Medicaid PC offices through in-office orientation visits. Highlights: 142 PC offices were targeted with 64%accepting an orientation visit in the first 3 months. Orientation visits were attended by 78% of office prescribers and lasted 46 minutes. Compared to offices not accepting visits, accepting offices covered more Medicaid lives, were located closer to the TiPS team home-site and more likely to be a pediatric than a family medicine practice (p’s To date, 50% of enrolled offices have called the TiPS line. The mean time to first call was 17 days. Over 70% of callers have called 2+ times, with mean time to the next call decreasing by 33%. The same factors predicted calling (p’s Sustainability/Transferability: Telephonic consult programs require less personnel and have lower costs than other integrated care services, making them a palatable and sustainable option for locales with limited behavioral health resources. In-office orientation visits were well received and led to program participation even by those with integrated behavioral health services. Larger pediatric practices, employing APCs, and located within 60 miles of the behavioral health team were most likely to enroll and call. Care coordination services have been well utilized and are a relatively inexpensive service, suggesting that they should comprise a core component of telephonic consultation services.

A View of the Whole Child - Patient Co-Design of a Communication and Information Tool to Support Complex Care

Introduction : The Sydney Children’s Hospitals Network (SCHN), in partnership with families, has designed a tool that supports families in navigating the health care system - the My Health Memory Integrated Care application (MHM). MHM provides all SCHN patients with a convenient app to access their SCHN information and communicate with clinicians. It further enables the families of children with complex and chronic conditions to manage the often overwhelming deluge of information and communication that they must coordinate within SCHN and across their local health services and community support agencies. Families are able to upload, tag, organise, search and store all documentation related to their child’s care in every setting – SCHN, local health services, primary care, the community, school and home. Practice Change Implemented : A co-design approach to the development of MHM was employed, involving families from the initial stages of the service design. They were interviewed to understand their challenges in accessing care for their children and then ‘shadowed’ through their interactions with the health and social care systems. After the initial round of consultation a ‘pretotype’ of MHM was developed, and families and were observed as they interacted with MHM. Aim and Theory of Change : To facilitate partner and patient co-design in developing an integrated model of care that helps families feel safe and supported wherever they access care. Targeted Population and Stakeholders : Children with complex and chronic conditions who are enrolled in the SCHN Care Coordination Service, where a care coordinator has helped to build a circle of coordination with the child at the centre, and a family, community and hospital lead who facilitate care in their setting. Stakeholders include – alongside our families and children - clinicians and management in the tertiary children’s hospitals, local hospitals, primary care, education and community Services agencies, and non-governmental organisations. Timeline : The prototype is currently under testing with the families initially engaged in the service design consultations. The app will be made available to the initial cohort in February 2017. Highlights : The co-design approach has moved the app away from a vision of families being able to access and control hospital-generated information about their child to being the family controlled centralised repository of information from a vast number of sources, that has the room and the flexibility to store everything that families need for the daily care of their child. Sustainability : The insights from the patient co-design have implications beyond the development of MHM. Understanding from this exercise will also influence the redesign of the network’s Outpatients Services and the continued evolution of the Integrated Care strategy. Transferability : There are significant similarities with the requirements for care for the frail elderly or adults with multiple chronic conditions, and the app will be easily transferable to these settings. Conclusions : Every minute spent on an additional tool needs to prove its value in tangible impact for the child, the family and what genuinely matters to them. The app needs to provide a way to immediately access critical data, while providing a view of longer-term context and have the flexibility to represent the personal care needs of each child. It needs to recognise the child as a whole, in the context of their family and their environment, and illustrate for clinicians ‘what matters to me’, ‘what’s normal for me’ and ‘how to communicate with me’.

Relevant models and elements of integrated care for multi-morbidity: Results of a scoping review

BackgroundIn order to provide adequate care for the growing group of persons with multi-morbidity, innovative integrated care programmes are appearing. The aims of the current scoping review were to i) identify relevant models and elements of integrated care for multi-morbidity and ii) to subsequently identify which of these models and elements are applied in integrated care programmes for multi-morbidity. MethodsA scoping review was conducted in the following scientific databases: Cochrane, Embase, PubMed, PsycInfo, Scopus, Sociological Abstracts, Social Services Abstracts, and Web of Science. A search strategy encompassing a) models, elements and programmes, b) integrated care, and c) multi-morbidity was used to identify both models and elements (aim 1) and implemented programmes of integrated care for multi-morbidity (aim 2). Data extraction was done by two independent reviewers. Besides general information on publications (e.g. publication year, geographical region, study design, and target group), data was extracted on models and elements that publications refer to, as well as which models and elements are applied in recently implemented programmes in the EU and US. ResultsIn the review 11,641 articles were identified. After title and abstract screening, 272 articles remained. Full text screening resulted in the inclusion of 92 articles on models and elements, and 50 articles on programmes, of which 16 were unique programmes in the EU (n=11) and US (n=5). Wagner’s Chronic Care Model (CCM) and the Guided Care Model (GCM) were most often referred to (CCM n=31; GCM n=6); the majority of the other models found were only referred to once (aim 1). Both the CCM and GCM focus on integrated care in general and do not explicitly focus on multi-morbidity. Identified elements of integrated care were clustered according to the WHO health system building blocks. Most elements pertained to ‘service delivery’. Across all components, the five elements referred to most often are person-centred care, holistic or needs assessment, integration and coordination of care services and/or professionals, collaboration, and self-management (aim 1). Most (n=10) of the 16 identified implemented programmes for multi-morbidity referred to the CCM (aim 2). Of all identified programmes, the elements most often included were self-management, comprehensive assessment, interdisciplinary care or collaboration, person-centred care and electronic information system (aim 2). ConclusionMost models and elements found in the literature focus on integrated care in general and do not explicitly focus on multi-morbidity. In line with this, most programmes identified in the literature build on the CCM. A comprehensive framework that better accounts for the complexities resulting from multi-morbidity is needed.

Payment for Integrated Care: Challenges and Opportunities.

A multidisciplinary team approach to care and robust care coordination services are primary components of almost all integrated care delivery systems. Given that these services have limited reimbursement in fee-for-service payment arrangements, integrating care in a fee-for-service environment is almost impossible. Capitated payment models hold promise for supporting integrated behavioral and physical health services. There are multiple national examples of integrated care delivery systems supported by capitated payment arrangements.

Expansion of inpatient clinical pharmacy services through reallocation of pharmacists.

The redesign of an inpatient pharmacy practice model through reallocation of pharmacy resources in order to expand clinical services is described. A pharmacy practice model change was implemented at a nonprofit academic medical center to meet the increasing demand for direct patient care services. In order to accomplish this change, the following steps were completed: reevaluation of daily tasks and responsibilities, reallocation of remaining tasks to the most appropriate pharmacy staff member, determination of the ideal number of positions needed to complete each task, and reorganization of the model into a collection of teams. Data were collected in both the preimplementation and postimplementation periods to assess the impact of the model change on operational workflow and clinical service expansion. The mean ± S.D. times to order verification were 17 ± 52 minutes during the preimplementation period and 21 ± 70 minutes in the postimplementation period (p < 0.001). During the 3 months before and after implementation of the model change, the mean number of medication reconciliations performed increased from 114 to 144. After implementation of the model change, total interventions increased 194%. Notably, there was a 736% increase in the number of interventions focused on facilitating safe discharge. A pharmacy practice model change was successfully implemented by reallocating existing pharmacist and technician roles and increasing incorporation of pharmacy residents and students. This change led to an expansion of direct patient care coordination services without negatively affecting the operational responsibilities of the pharmacy or the need to hire additional staff.

Enhancing State Medical Home Capacity through a Care Coordination Technical Assistance Model.

Introduction A practice-based care coordination (CC) model was developed by Louisiana's Title V Children's Special Health Services (CSHS) program to meet the overwhelming needs of the New Orleans post-Katrina population. The pilot clinic demonstrated an improvement in medical home (MH) capacity over the course of 3 months. The purpose of the current study is to evaluate the replicability of the model and sustainability of MH improvement over at least 2 years, while identifying factors that may modify the effect of the intervention. Methods The CSHS CC model utilizing a practice based care coordinator was implemented in 15 academic primary care pediatric clinics. Increase in MH capacity was determined using the MH Index-Short Version (MHI-SV) tool. Results The analysis of the MHI-SV scores for the ten clinics with >2 years of data demonstrated a significant improvement with each of the ten MHI-SV indicators. The mean clinic MHI-SV score improved from 19.70 to 34.15 on a scale of 10-50. Characteristics associated with the greatest MHI score improvement were rural geographic location, having an electronic health record, and using social workers or nurses as care coordinators. Characteristics associated with lower MHI scores were physician or care coordinator turnover and using stand-alone databases rather than tracking CC activities within the central patient record. Conclusion This study provides a flexible framework for implementing CC services in pediatric, family medicine, and medicine-pediatric practices, and demonstrates the value of CC as a driver for improvement in medical home capacity.

Kids GPS Integrated Care - Leaving the Ivory Tower

Introduction : Children are increasingly surviving antenatally with complex and chronic conditions. Their families face significant challenges in navigating the health system, and managing transport, cost, and school and work days missed to access care from the network of tertiary children’s hospitals in NSW - Sydney Children's Hospitals Network. Transformational change is required from this organisation, frequently seen as an ivory tower that isolates children from primary care and local health services. Practice change implemented : Partnerships have been formed with local hospitals and general practitioners, to support an integrated model of care that helps families feel safe wherever they are accessing health services. Care Coordinators are responsible for facilitating shared care models, identifying opportunities to localise care and guiding the child and their family in navigating the health system. The project is using a QI framework, with each of the project streams testing the model of care conducting a series of Plan, Do, Study, Act cycles to refine the model through the experience of each child referred to the program. Aim and theory of change : The aim is for everyone to understand their role in a child’s care plan and feel supported in their work, and for families to feel connected to their local health services. There is emerging evidence that Care Coordination decreases Emergency Department presentations and admissions, and increases parental satisfaction and family functioning. Targeted population and stake holders : The cohorts amongst this population include babies discharged from the neonatal intensive care unit; children with naso-gastric and gastro-jejunal feeding tubes; school children in rural areas; children who present frequently to ED with asthma; and children with food allergies. 160 care professionals have partnered with the Kids GPS initiative, ranging from sub-specialists, paediatricians and nurses, to GPs and Allied Health practitioners in the community. Timeline : The project commenced in 2015 and is currently implementing across three regions. Highlights : Amongst the 190 children enrolled in the Care Coordination service, an estimated 36,500kms in travel and 168 day only admissions have been avoided in the year to June 2016. The program has facilitated GP engagement for more than thirty families who did not have a relationship with a general practitioner when initially enrolled. A parent activation measure is being used to establish a measure of parental satisfaction and empowerment in their involvement in their child’s care. Sustainability : The cultural change, cross-boundary clinical networks and system capacity created by the project will continue to support the Care Coordinators – a permanently funded clinical service – after the project’s conclusion. Transferability : The model tested within the initial cohorts will become standard practice for the Care Coordination Team. Conclusions : Children with even the most complex of conditions can have elements of their care delivered safely in the community provided there is open communication and support available to everyone in the care team, including the family. Lessons learned : A QI framework allows the project to start small and continue to refine as it scales, and the incremental change does not feel threatening to the participants.

Governing the coordination of care for older people: Comparing care agreements in Denmark and Norway

Increasing specialisation and demands to decrease the length of hospital stays have important consequences for the integration of specialised health and local care services. Based on case studies of care agreements in Denmark and Norway, this article compares subnational governance strategies for coordinating care services for older people discharged from hospitals. The question is how, and to what degree, national government regulations have an impact on local service coordination strategies. The analysis reveals that the numerous subnational procedures for coordination are somewhat more itemised in Denmark, and that regional variation in care agreements is greater in Norway. The identified differences can partly be accounted for by national differences in regulation, which is tighter in Denmark than in Norway. The study suggests that despite decentralisation of responsibility, subnational procedures to facilitate coordination are heavily influenced by national government policy.

Care Coordination Services: A Description of an Alternative Service Model for At-Risk Families

ABSTRACTObjective: The objective of this article is to describe a care coordination model that includes promising practices which are supported by both practice-based and research-based evidence. This model was developed to address the gaps of other models, namely an emphasis on skill teaching with parents, the flexibility to adapt to the needs of youth with a wide variety of presenting problems, and model fidelity assessment tools to help scale up the program across multiple locations with fidelity.Method: We discuss preliminary administrative and outcome data from 898 youth served across eight locations.Results: Data suggest positive outcomes at departure from service, as well as 6 months and 12 months post case closure.Conclusion: Preliminary data indicate that youth with educational and behavioral health challenges can benefit from coordination of services that are both youth guided and family driven. As this program has been scaled up and has an established vehicle of dissemination, it is in a unique position to be tested via more highly controlled and rigorous efficacy trials.

Parent Perspective on Care Coordination Services for Their Child with Medical Complexity.

The overarching goal of care coordination is communication and co-management across settings. Children with medical complexity require care from multiple services and providers, and the many benefits of care coordination on health and patient experience outcomes have been documented. Despite these findings, parents still report their greatest challenge is communication gaps. When this occurs, parents assume responsibility for aggregating and sharing health information across providers and settings. A new primary-specialty care coordination partnership model for children with medical complexity works to address these challenges and bridge communication gaps. During the first year of the new partnership, parents participated in focus groups to better understand how they perceive communication and collaboration between the providers and services delivering care for their medically complex child. Our findings from these sessions reflect the current literature and highlight additional challenges of rural families, as seen from the perspective of the parents. We found that parents appreciate when professional care coordination is provided, but this is often the exception and not the norm. Additionally, parents feel that the local health system’s inability to care for their medically complex child results in unnecessary trips to urban-based specialty care. These gaps require a system-level approach to care coordination and, consequently, new paradigms for delivery are urgently needed.

Do Maternity Care Coordination Services Encourage Use of Behavioral Health Treatment among Pregnant Women on Medicaid?

ObjectiveMaternity care coordination (MCC) may provide an opportunity to enhance access to behavioral health treatment services. However, this relationship has not been examined extensively in the empirical literature. This study examines the effect of MCC on use of behavioral health services among perinatal women. MethodsMedicaid claims data from October 2008 to September 2010 were analyzed using linear fixed effects models to investigate the effects of receipt of MCC services on mental health and substance use–related service use among Medicaid-eligible pregnant and postpartum women in North Carolina (n = 7,406). ResultsReceipt of MCC is associated with a 20% relative increase in the contemporaneous use of any mental health treatment (within-person change in probability of any mental health visit 0.5% [95% CI, 0.1%–1.0%], or an increase from 8.3% to 8.8%); MCC in the prior month is associated with a 34% relative increase in the number of mental health visits among women who receive MCC (within-person change in the number of visits received 1.7% [95 CI, 0.2%–3.3%], or from 0.44 to 0.46 mental health visits). No relationship was observed between MCC and Medicaid-funded substance use–related treatment services. ConclusionsMCC may be an effective way to quickly address perinatal mental health needs and engage low-income women in mental health care. However, currently there may be a lost opportunity within MCC to increase access to substance use–related treatment. Future studies should examine how MCC improves access to mental health care such that the program's ability can be strengthened to identify women with substance use–related disorders and transition them into available care.