TORONTO — A designated care coordinator can significantly improve the management of children and youth with special health care needs, Mary Krauthoefer said at the annual meeting of the Pediatric Academic Societies.
“Complex, medically fragile children with special health care needs require thorough communication and coordination among providers, which are best directed through the primary care setting,” said Ms. Krauthoefer, case manager at Children's Hospital of Wisconsin in Milwaukee. “But this [service] is time consuming and poorly reimbursed, making it difficult for primary care physicians alone to provide medical homes for this population.”
Care coordination provided by a pediatric nurse manager at the Children's Hospital of Wisconsin resulted in more efficient and effective use of resources among these complex patients, according to study results Ms. Krauthoefer presented at the meeting.
She described a Special Needs Program, set up by the hospital, which was established to partner with families and primary care physicians to ensure care coordination. A pediatric nurse manager served as the tertiary center care coordinator for 219 patients with special health care needs enrolled in the program. All patients met complexity and fragility criteria—the presence of five or more specialists, uncertain or multiple diagnoses, use of multiple community services, and frequent visits to a hospital and clinic.
In examining resource utilization among the patients during equal time periods both before and after the implementation of care coordination, the investigators found care coordination resulted in a decreased number of hospital days and an increased number of clinic visits, indicating a shift from inpatient to outpatient care. Hospital length of stay for all patients combined declined by a total of 2,790 days; outpatient clinic visits increased by a total of 1,878 days. There were approximately the same number of hospital admissions as before. Hospital charges and payments decreased by $2.8 million and $2.7 million, respectively.
Surveys of families and patients' primary care physicians indicated a high level of satisfaction with the care coordination initiative, Ms. Krauthoefer said.