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Care coordination, medical homes improve specialty care for special needs children
Care coordination and medical homes improved patient and parent satisfaction with specialty care for children with special needs, according to study findings in Pediatrics.
Alexy Arauz Boudreau, MD, MPH, of Massachusetts General Hospital for Children in Boston, and colleagues analyzed data from the 2009 to 2010 National Survey of Children with Special Health Care Needs survey. Data was based on telephone interviews with parents of special needs children aged 0 to 17 years. The study cohort consisted of 18, 905 children.
Alexy Arauz Boudreau
More than half of the study cohort was white non-Hispanic and had at least one parent with more than a high school education. Approximately one-third of study participants lived in households with a federal poverty level greater than 400%.
Overall, 9% of children reported their specialty care needs were unmet. Sixteen percent reported that their family usually or always received care coordination without a medical home, while 39% reported receiving care coordination within a medical home.
As the federal poverty level increased, unmet specialty care needs decreased. Across all federal poverty levels, the number of families who reported unmet needs was lowest among those who received care coordination within a medical home. Low-income households were more likely to report unmet specialty care needs compared with high-income households.
Those who received care coordination within and without a medical home were more likely to report unmet specialty care needs compared with families who reported no care coordination. After adjusting for age, gender, race, insurance type, continual insurance throughout the year, financially burdening medical expenses, receiving preventive care in the past year, and primary language spoken at home, study participants who received care coordination without a medical home were one-third less likely to report unmet needs compared with those without care coordination. Parents of children who received care coordination within a medical home were three-quarters less likely to report unmet needs compared with those without care coordination.
Overall, care coordination was associated with decreased unmet specialty care needs, regardless of medical home status. However, children who received care coordination in a medical home were less likely to report unmet needs than those who received care coordination without a medical home.
“Our findings support the notion that care coordination and the medical home may improve access to care. We show that the provision of care coordination to [children with special health care needs] is associated with decreased unmet specialty care needs. Furthermore, we demonstrate that the likelihood of family-reported unmet specialty care need is smallest among those whose care coordination is provided in the context of a medical home.
Although children living in higher income brackets may be better equipped to harness benefits provided by care coordination, low-income children may gain improved access to needed specialty care with access to care coordination within and even without a medical home,” the researchers concluded. — by Amanda Oldt
Disclosure: The researchers report no relevant financial disclosures.
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The article by Arauz Boudreau and associates examines the impact of care coordination for the health of children with special health care needs. It shows that coordination of care improves parent reported access to specialty services. This cuts across all income levels. Although this is study proves what most pediatricians already know, it is nice to see these conclusions in such a large sample. This population of children and their parents need strong advocates among primary care providers in order to get the kind of care needed. Access is also welcome from those same primary care providers who take on complex patients. Without the backup of specialists, the work on the front lines for these providers is daunting and some push back is inevitable. This study was conducted on samples from 2007 forward. Now we need to follow this issue into the new era of new health care legislation that sets out higher standards for coordination and a medical home. I would like to see papers that go beyond parent reports and look at objective health and welfare measures.
