Care Coordination Over Time in Medical Homes for Children With Special Health Care Needs

摘要: OBJECTIVES: To explore how care coordination changes conceptually and practically in primary practices when implementing the medical home to identify reasons for different types of changes. METHODS: Six years after a 2003–2004 national learning collaborative implement model children with special health needs, we examined 12 pediatric highest postintervention Medical Home Index scores, indicating high level adoption model. Data included interviews 48 clinicians, coordinators, parents record reviews 60 patients needs receiving these practices. RESULTS: Initially, activities were prompted by patients’ acute problems, over time activities, tools, policies implemented avert many such problems expand scope services offered patients. Example making previsit calls families, writing plans, developing relationships community agencies, tracking referrals. Although some common across practices, persons involved efforts toward varied practice context. Drivers motivation creativity teams, organizational changes, funding coordinator positions, protected electronic systems. CONCLUSIONS: In high-performing homes, changed from being mostly reactive episodic more systematically proactive comprehensive. This shift was promoted factors external internal practice. Ensuring implementation may accelerate activities.