Receipt Of Care Coordination Research Articles

Intensity, Characteristics, and Factors Associated With Receipt of Care Coordination Among High-Risk Veterans in the Veterans Health Administration.

The Veterans Health Administration (VHA) has initiatives underway to enhance the provision of care coordination (CC), particularly among high-risk Veterans. Yet, evidence detailing the characteristics of and who receives VHA CC is limited. We examined intensity, timing, setting, and factors associated with VHA CC among high-risk Veterans. We conducted a retrospective observational cohort study, following Veterans for 1 year after being identified as high-risk for hospitalization or mortality, to characterize their CC. Demographic and clinical factors predictive of CC were identified via multivariate logistic regression. A total of 1,843,272 VHA-enrolled high-risk Veterans in fiscal years 2019-2021. We measured 5 CC variables during the year after Veterans were identified as high risk: (1) receipt of any service, (2) number of services received, (3) number of days to first service, (4) number of days between services, and (5) type of visit during which services were received. Overall, 31% of high-risk Veterans in the sample received CC during one-year follow-up. Among Veterans who received ≥1 service, a median of 2 [IQR (1, 6)] services were received. Among Veterans who received ≥2 services, there was a median of 26 [IQR (10, 57)] days between services. Most services were received during outpatient psychiatry (46%) or medicine (16%) visits. Veterans' sociodemographic and clinical characteristics were associated with receipt of CC. A minority of Veterans received CC in the year after being identified as high-risk, and there was variation in intensity, timing, and setting of CC. Research is needed to examine the fit between Veterans' CC needs and preferences and VHA CC delivery.

1212-P: Cost-Related Medication Nonadherence in Alabama's Medicaid Population with Diabetes

Background: Cost-related medication nonadherence (CRMN) occurs when an individual takes less medication than what is prescribed due to difficulty affording their medications. In adults with diabetes, medication nonadherence is associated with worse glycemic control and increased healthcare costs. The goal of this study was to determine what proportion of Alabama’s Medicaid population with diabetes experiences CRMN and to evaluate for potential risk factors for CRMN in this financially-at-risk population. Methods: We conducted a cross-sectional study surveying a population-based sample of adults (ages 19-64) with diabetes covered by Alabama Medicaid. We classified participants as experiencing CRMN if they responded yes to “Not including over the counter medications, was there a time in the past 12 months when you didn't take your medication as prescribed because of cost?” Using multivariable logistic regression, we examined what variables were associated with CRMN adjusting for demographic and clinical factors (insulin use, diabetes duration, receipt of care coordination, and self-rated health) . Results: We included 1893 of 2235 (84.7%) participants who completed the survey and had complete data for the variables of interest in the analysis. This sample was predominantly nonwhite (60.7%) , female (73.9%) with a mean age of 52 ±10.1 years. Overall, 23.7% of participants reported CRMN. In the fully adjusted model, insulin use (OR 1.41, 95% CI 1.11, 1.79) , use of a discount prescription plan (OR 1.55, 95% CI 1.20, 2.00) , and self-report of poor health (OR 1.67, 95% CI 1.33, 2.09) were significantly associated with CRMN. Conclusion: We found that almost a quarter of a population-based sample of adults with diabetes covered by Alabama Medicaid experienced cost-related medication nonadherence. More research is needed to determine how to address this among this vulnerable population. Disclosure E.C.Ness: None. L.Juarez: None. C.R.Howell: None. L.Hohmann: None. A.Cherrington: Consultant; Bayer AG, Other Relationship; Novo Nordisk. C.A.Presley: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R18DK109501) UAB Diabetes Research Center (P30 DK079626)

Access to the Medical Home Among Children With and Without Special Health Care Needs.

We used data from the 2016 NSCH (N = 50 212). Medical home access was defined as a composite measure composed of 5 subcomponents (usual source of care, personal doctor or nurse, referral access, receipt of care coordination, and receipt of family-centered care) for 50 177 US children aged 0 to 17 years. We conducted bivariate analyses and logistic regression to examine the sociodemographic and health characteristics associated with reported attainment of the medical home composite measure and each subcomponent. Analyses were survey weighted. In 2016, 43.2% of children with special health care needs (CSHCN) and 50.0% of non-CSHCN were reported to have access to a medical home. Attainment of the medical home composite measure varied significantly by sociodemographic characteristics among both CSHCN and non-CSHCN, as did attainment rates for each of the 5 subcomponents. The medical complexity of CSHCN was also associated with attainment rates of all outcomes. The medical home incorporates elements of care considered necessary for providing comprehensive, quality care. Our results indicate that there is still room to improve access to the medical home among all children.

Transition Planning Among US Youth With and Without Special Health Care Needs

Researchers have shown that most youth with special health care needs (YSHCN) are not receiving guidance on planning for health care transition. This study examines current transition planning among US youth with and without special health care needs (SHCN). The 2016 National Survey of Children's Health is nationally representative and includes 20 708 youth (12-17 years old). Parents and/or caregivers were asked if transition planning occurred, based on the following elements: (1) doctor or other health care provider (HCP) discussed the eventual shift to an HCP who cares for adults, (2) an HCP actively worked with youth to gain self-care skills or understand changes in health care at age 18, and (3) youth had time alone with an HCP during the last preventive visit. Sociodemographic and health system characteristics were assessed for associations with transition planning. Nationally, 17% of YSHCN and 14% of youth without SHCN met the overall transition measure. Older age (15-17 years) was the only sociodemographic factor associated with meeting the overall transition measure and individual elements for YSHCN and youth without SHCN. Other sociodemographic characteristics associated with transition planning differed among the 2 populations. Receipt of care coordination and a written plan was associated with transition planning for YSHCN. This study reveals that few youth with and without SHCN receive transition planning support. It underscores the need for HCPs to work with youth independently and in collaboration with parents and/or caregivers throughout adolescence to gain self-care skills and prepare for adult-focused care.

Care Coordination in Emergency Departments for Children and Adolescents With Behavioral Health Conditions: Assessing the Degree of Regular Follow-up After Psychiatric Emergency Department Visits.

Increasing numbers of children are receiving care for behavioral health conditions in emergency departments (EDs). However, studies of mental health-related care coordination between EDs and primary and/or specialty care settings are limited. Such coordination is important because ED care alone may be insufficient for patients' behavioral health needs. We analyzed claims during the year 2014 from Truven Health Analytics MarketScan Medicaid and Commercial databases for outpatient services and prescription drugs for youth 2 to 18 years old with continuous enrollment. We applied a standard care coordination measure to insurance claims data in order to examine whether youth received a primary care or specialty follow-up visit within 7 days following an ED visit with a psychiatric diagnosis. We calculated descriptive statistics to evaluate differences in care coordination by enrollees' demographic, insurance, and health-related characteristics. In addition, we constructed a multivariate logistic regression model to detect the factors associated with the receipt of care coordination. The total percentages of children who received care coordination were 45.8% (Medicaid) and 46.6% (private insurance). Regardless of insurance coverage type, children aged 10 to 14 years had increased odds of care coordination compared with youth aged 15 to 18 years. Children aged 2 to 5 years and males had decreased odds of care coordination. It is of concern that fewer than half of patients received care coordination following an ED visit. Factors such as behavioral health workforce shortages, wait times for an appointment with a provider, and lack of reimbursement for care coordination may help explain these results.

Medicaid Managed Care Structures and Care Coordination.

Child enrollment in Medicaid managed care (MMC) has expanded dramatically, primarily through state mandates. Care coordination is a key metric in MMC evaluation because it drives much of the proposed cost savings and may be associated with improved health outcomes and utilization. We evaluated the relationships between enrollment in 2 MMC structures, primary care case management (PCCM) and health maintenance organization (HMO) and access to and receipt of care coordination by children. Using data from the 2011/2012 National Survey of Children's Health and the Medicaid Statistical Information System state data mart, we conducted a retrospective, cross-sectional analysis of the relationships between fee-for-service, PCCM or HMO enrollment, and access to and receipt of care coordination. State-level univariate analyses and individual and state multilevel multivariable analyses evaluated correlations between MMC enrollment and care coordination, controlling for demographic characteristics and state financing levels. In univariate and multilevel multivariable analyses, the PCCM penetration rate was significantly associated with increased access to care coordination (adjusted odds ratio: 1.23, P = .034) and receipt of care coordination (adjusted odds ratio: 1.37, P = .02). The HMO penetration rate was significantly associated with lower access to care coordination (adjusted odds ratio: 0.85, P = .05) and receipt of care coordination (adjusted odds ratio: 0.71, P < .001). Fee-for-service served as the referent. State utilization of MMC varied widely. These data suggest that care coordination may be more effective in PCCM than HMO structures. States should consider care coordination outcomes when structuring their Medicaid programs.

Incentivizing Care Coordination in Managed Care.

* Abbreviations: CMC — : children with medical complexity CSHCN — : children with special health care needs HMO — : health maintenance organization NSCH — : National Survey of Children’s Health PCCM — : primary care case management Care coordination for children remains one of the least-understood, widespread practice and policy interventions in pediatrics. In “Medicaid Managed Care Structures and Care Coordination: A National Cross-Sectional Analysis,” Gilchrist-Scott and colleagues examine the degree to which state penetrance of Medicaid managed care structures (specifically, health maintenance organizations [HMOs] versus primary care case management [PCCM]) may incentivize care coordination. They find that states with lower HMO and higher PCCM penetrance exhibited greater care coordination on 2 parent-reported National Survey of Children’s Health (NSCH) metrics: access to care coordination and receipt of care coordination when needed. Given that NSCH data were cross-sectional and penetrance data were aggregated by state, no causal inferences can be made, but the findings are intriguing nonetheless. From low to high quintiles of HMO penetrance (and, conversely, from high to low quintiles of PCCM penetrance), access to care coordination fell roughly 5 percentage points, and receipt of care coordination when needed fell roughly 10 percentage points. This finding is not subtle and suggests that the choice of incentive structure may matter. Nor is this finding surprising, given the incentive structures themselves. Unlike PCCM, fully … Address correspondence to Paul J. Chung, MD, MS, Department of Pediatrics, University of California – Los Angeles, 10833 LeConte Ave, B2-433 MDCC, Los Angeles, CA 90095. E-mail: paulchung{at}mednet.ucla.edu

Evaluation of prediction strategy and care coordination for COPD readmissions

ABSTRACTObjectives: Factors that influence the likelihood of readmission for chronic obstructive pulmonary disease (COPD) patients and the impact of posthospital care coordination remain uncertain. LACE index (L = length of stay, A = Acuity of admission; C = Charlson comorbidity index; E = No. of emergency department (ED) visits in last 6 months) is a validated tool for predicting 30-days readmissions for general medicine patients. We aimed to identify variables predictive of COPD readmissions including LACE index and determine the impact of a novel care management process on 30-day all-cause readmission rate.Methods: In a case-control design, potential readmission predictors including LACE index were analyzed using multivariable logistic regression for 461 COPD patients between January-October 2013. Patients with a high LACE index at discharge began receiving care coordination in July 2013. We tested for association between readmission and receipt of care coordination between July-October 2013. Care coordination consists of a telephone call from the care manager who: 1) reviews discharge instructions and medication reconciliation; 2) emphasizes importance of medication adherence; 3) makes a follow-up appointment with primary care physician within 1–2 weeks and; 4) makes an emergency back-up plan.Results: COPD readmission rate was 16.5%. An adjusted LACE index of ≥ 13 was not associated with readmission (p = 0.186). Significant predictors included female gender (odds ratio [OR] 0.51, 95% confidence interval [CI] 0.29–0.91, p = 0.021); discharge to skilled nursing facility (OR 3.03, 95% CI 1.36–6.75, p = 0.007); 4–6 comorbid illnesses (OR 9.21, 95% CI 1.17–76.62, p = 0.035) and ≥ 4 ED visits in previous 6 months (OR 6.40, 95% CI 1.25–32.87, p = 0.026). Out of 119 patients discharged between July-October 2013, 41% received the care coordination. The readmission rate in the intervention group was 14.3% compared to 18.6% in controls (p = 0.62).Conclusions: Factors influencing COPD readmissions are complex and poorly understood. LACE index did not predict 30-days all-cause COPD readmissions. Posthospital care coordination for transition of care from hospital to the community showed a 4.3% reduction in the 30-days all-cause readmission rate which did not reach statistical significance (p = 0.62).

Promoting Child Health Equity: Family-Centered Care Coordination Is Just One Piece of the Puzzle

In their report in this month’s issue of Pediatrics , Toomey et al1 analyzed data from the National Survey of Children’s Health related to parental rating of their children’s receipt of care coordination. The authors found that 41% of all parents, and 72% of parents of children with special health care needs, reported that their child needed some type of care coordination. However, almost one-third of those reporting the need for care coordination perceived their needs to be unmet. Not surprisingly, Latino and African American children, low income, uninsured children and those with public insurance, non-English speaking-families, single-parent households, children without a personal healthcare provider, and children and youth with special health care needs were more likely to report ineffective care coordination. In the multivariable analyses, receipt of culturally competent, family-centered care mitigated the racial/ethnic disparities in care coordination. The study demonstrates that family-centered care, a central characteristic of which is cultural sensitivity and competency, helps to mitigate racial/ethnic disparities in the receipt of care coordination. Cultural competency is an … Address correspondence to David L. Wood, MD, MPH, 580 W 8th St, Room 6015, Jacksonville, FL 32209. E-mail: david.wood{at}jax.ufl.edu

Associations between State Economic and Health Systems Capacities and Service Use by Children with Special Health Care Needs

To examine the relationship between measures of state economic, political, health services, and Title V capacity and individual level measures of the well-being of CSHCN. We selected five measures of Title V capacity from the Title V Information System and 13 state capacity measures from a variety of data sources, and eight indicators of intermediate health outcomes from the National Survey of Children with Special Health Care Needs. To assess the associations between Title V capacity and health services outcomes, we used stepwise regression to identify significant capacity measures while accounting for the survey design and clustering of observations by state. To assess the associations between economic, political and health systems capacity and health outcomes we fit weighted logistic regression models for each outcome, using a stepwise procedure to reduce the models. Using statistically significant capacity measures from the stepwise models, we fit reduced random effects logistic regression models to account for clustering of observations by state. Few measures of Title V and state capacity were associated with health services outcomes. For health systems measures, a higher percentage of uninsured children was associated with decreased odds of receipt of early intervention services, decreased odds of receipt of professional care coordination, and increased odds of delayed or missed care. Parents in states with higher per capita Medicaid expenditures on children were more likely to report receipt of special education services. Only two state capacity measures were associated explicitly with Title V: states with higher generalist physician to population ratios were associated with a greater likelihood of parent report of having heard of Title V and states with higher per capita gross state product were less likely to be associated with a report of using Title V services, conditional on having heard of Title V. The state level measure of family participation in Title V governance was negatively associated with receipt of care coordination and having used Title V services. The measures of state economic, political, health systems, and Title V capacity that we have analyzed are only weakly associated with the well-being of children with special health care needs. If Congress and other policymakers increase the expectations of the states in assuring that the needs of CSHCN and their families are addressed, it is essential to be cognizant of the capacities of the states to undertake that role.