Lessons Learned, Best Practices: Care Coordination for Children with Medical Complexity.

Although care coordination has long been established in the health care system in the United States, too often it may compete or work at cross purposes with care teams serving patients and families. Care coordination is a team sport that requires strong clinician-family partnerships as well as adequate time and resources to be done effectively. We incorporate the latest literature to offer clarity for identifying, coordinating, and funding care for children with medical complexity (CMC), the most medically fragile, high-cost subpopulation of children and youth with special health care needs.

Home Visits for Children With Asthma Reduce Medicaid Costs.

We conducted a multicomponent, low-cost, home intervention for children with uncontrolled asthma, the Reducing Ethnic/Racial Asthma Disparities in Youth (READY) study, to evaluate its effect on health outcomes and its return on investment. From 2009 through 2014 the study enrolled 289 children aged 2 to 13 years with uncontrolled asthma and their adult caregivers in Boston and Springfield, Massachusetts. Community health workers (CHWs) led in-home asthma management and environmental trigger remediation education over 5 visits spanning 6 months.

Care coordination for children with medical complexity.

Purpose Of Review: We review the literature to help the reader better understand the latest thinking on how best to identify, coordinate and fund care for children with medical complexity, a medically fragile high-cost subpopulation of children and youth with special healthcare needs.

Recent Findings: Proprietary and public algorithms have been developed to identify children with medical complexity. Research on families and healthcare providers of children with medical complexity have identified essential components of effective care coordination.

A Step-by-Step Guide to Building a Complex Care Coordination Program in a Small Setting.

Children with medical complexity comprise a growing population that stresses existing models of pediatric care. This report will describe a care support project that delivered shared plans of care to providers and families of children with medical complexity. This program was built around carefully constructed care support teams where each member had clearly defined roles and responsibilities.

Redesigning Health Care Practices to Address Childhood Poverty.

Child poverty in the United States is widespread and has serious negative effects on the health and well-being of children throughout their life course. Child health providers are considering ways to redesign their practices in order to mitigate the negative effects of poverty on children and support the efforts of families to lift themselves out of poverty. To do so, practices need to adopt effective methods to identify poverty-related social determinants of health and provide effective interventions to address them.

Determinants of Health and Pediatric Primary Care Practices.

More than 20% of children nationally live in poverty. Pediatric primary care practices are critical points-of-contact for these patients and their families. Practices must consider risks that are rooted in poverty as they determine how to best deliver family-centered care and move toward action on the social determinants of health.

Medically Complex Care: The Newest Competency for Primary Care?

Nola is a complicated 22-month (19-mo corrected) former 34-week premature girl who presents to your practice in the company of her foster caretaker, a maternal aunt. The history you have comes mostly through the lens of her aunt's recall of a variety of clinical encounters and emergency room visits that have taken place at 2 of the region's tertiary care centers, including a prolonged recent hospitalization for failure to thrive. Regrettably, you have no discharge summary on hand from the outside institution.

Transition of adolescents with chronic health conditions to adult primary care: factors associated with physician acceptance.

Purpose: To assess the willingness of adult primary-care physicians to transfer young adults with special health care needs (YASHCN) into their practices, and the relative impact of patient characteristics and transition supports.

Methods: Survey of primary care internists and family practitioners using randomized patient characteristics and transition supports in clinical vignettes to assess physician willingness to accept a YASHCN into their practice.

Results: 404 responses were received from 601 surveys (response rate 67%).

Adolescent asthma: a developmental approach.

Purpose Of Review: The purpose of this review is to update providers on how best to address asthma in adolescents.

Recent Findings: Asthma is a common chronic disease, with increased prevalence in minority populations, especially those living in poverty. Published treatment guidelines form the basis of modern asthma treatment, based on disease severity, frequency of symptoms, and lung function measured by spirometry.

Unmet dental needs and barriers to care for children with significant special health care needs.

Purpose: The purpose of this study was to conduct the first known large scale survey of parents of children with special health care needs (CSHCN) to determine their child's: oral health status; access to dental care; perceived barriers (environmental/system and nonenvironmental/family); and oral health quality of life, accounting for each child's medical diagnosis and severity of diagnosis.

Methods: A 72-item survey was sent to 3760 families of CSHCN throughout urban and rural Massachusetts.

Results: The study yielded 1,128 completed surveys.

Identifying what pediatric residents are taught about children and youth with special health care needs and the medical home.

Objective: To describe what and how pediatric residents in Massachusetts are taught about children and youth with special health care needs (CYSHCN) and the medical home.

Participants And Methods: Faculty members and residents at Massachusetts' 5 pediatric residency programs were interviewed to identify current curricula and teaching methods related to care of CYSHCN. In addition, residents were surveyed to quantify these concepts.

How to best deliver care to children with chronic illness: cystic fibrosis as a model.

Purpose Of Review: Children with special healthcare needs benefit when there is close coordination of care for their chronic disease between specialists and primary care providers. The importance of coordination between primary and specialty care has become better recognized with the increased attention to a comprehensive 'medical home' model of care.

Recent Findings: Care coordination requires close communication between primary care providers and specialty care centers.

Care coordination for children with special health care needs: evaluation of a state experiment.

Care coordination (CC), a component of the medical home, may aid families who have children with special health care needs (CSHCN). Few data link CC to individual patient outcomes. To compare parent-reported outcomes for CSHCN receiving practice-based care coordination with those receiving standard care.

An analysis of predictors of sustainability efforts at the Inner-City Asthma Intervention sites: after the funding is gone.

Background: The Inner-City Asthma Intervention was a national, multicenter implementation of an evidence-based intervention to reduce asthma morbidity in inner-city children that was funded by the Centers for Disease Control and Prevention. Funding was initially planned for 4 years beginning in April 2001, but because of budgetary changes funding ceased in September 2004, 6 months before the original plan. Some sites were able to sustain their asthma program when the funding ended and others were not.

The adolescent with a chronic illness.

The primary care clinician can play an important role in enhancing the quality of life for the adolescent with chronic illness through developmentally appropriate, individualized and compassionate coordination of care (Sidebar 2). Special attention to the process of adolescence, family, and psychological issues are required for successful management. Transition of care to adult services should be planned carefully with a multidisciplinary team.

Dipstick leukocyte esterase activity in first-catch urine specimens. A useful screening test for detecting sexually transmitted disease in the adolescent male.

Although sexually active female adolescents are often routinely screened for sexually transmitted diseases, indications for culturing adolescent males for sexually transmitted urethral infections are controversial. A study of 54 sexually active males (14 to 22 years old) was undertaken to assess the reliability of using dipstick leukocyte esterase activity in first-catch urine specimens to detect urethritis caused by Neisseria gonorrhoeae and Chlamydia trachomatis. Eighteen males had sexually transmitted diseases: N gonorrhoeae (nine patients), C trachomatis (eight patients), and N gonorrhoeae and C trachomatis (one patient).

L-phenylalanine mustard-dianhydrogalactitol and hyponatremia.

The incidence of hyponatremia in 34 patients following administration of high-dose L-phenylalanine mustard (L-PAM) and dianhydrogalactitol (DAG) was determined. Two consecutive daily levels of 133 mEq/l or less were observed in 12 patients. These episodes coincided with the advent of diarrhea about 10-12 days after drug administration.