Integrated complex care coordination for children with medical complexity: A mixed-methods evaluation of tertiary care-community collaboration

摘要: Abstract Background Primary care medical homes may improve health outcomes for children with special healthcare needs (CSHCN), by improving coordination. However, community-based primary practices be challenged to deliver comprehensive coordination complex subsets of CSHCN such as complexity (CMC). Linking a tertiary center the community achieve cost effective and high quality CMC. The objective this study was evaluate clinics integrated center. Methods A before- after-intervention design mixed (quantitative/qualitative) methods utilized. Clinics at two hospitals distant from were staffed local pediatricians nurse practitioner linked providers. Eighty-one underlying chronic conditions, fragility, requirement intensity and/or technology assistance, involvement multiple providers participated. Main outcome measures included utilization expenditures, parent reports parent- child-quality life [QOL (SF-36®, CPCHILD © , PedsQL™)], family-centered (MPOC-20®). Comparisons made in equal (up 1 year) pre- post-periods supplemented qualitative perspectives families pediatricians. Results Total system costs decreased median (IQR) $244 (981) per patient month (PPPM) pre-enrolment $131 (355) PPPM post-enrolment (p=.007), driven primarily fewer inpatient days (p=.006). Parents reported out pocket expenses (p domains [Health Standardization Section (p=.04); Comfort Emotions (p=.03)], while total score between baseline year (p=.003). ability receive close home key benefit. Conclusions Complex can provided settings less direct through an clinic. Improvements family-centeredness achieved despite minimal changes parental perceptions child health.