PEDIATRIC ALLIANCE FOR COORDINATED CARE

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					       Improving Quality
The Pediatric Alliance for Coordinated Care:
 A Medical Home for Children with Special
             Health Care Needs

          Judith S. Palfrey, M.D.
        Children’s Hospital, Boston
                June, 2004
      Pediatric Alliance For
        Coordinated Care
• Six pediatric practices joined together to
  improve care for Children with Special
  Health Care Needs
• Research/service demonstration project
• Funding from RWJ, BMCH, Children’s
  Hospital
• Cooperation from Medicaid and private
  insurers
              Goals of PACC
• Enhance Clinical Care & Coordination
    – Improve Health Outcomes
    – Reduce Family Stress
•   Profile Children w/ Spec. Health Care Needs
•   Reduce Unplanned Hospital and ER Use
•   Disseminate Model
•   Sustain/Replicate Concept w/out Grant
    Funding
            The Intervention

                 LPC
8 hrs PNP   +   Stipend   +    IHP   +   CME/CEU


                      Totals
            ~$15,000/yr/practice
Nurse Practitioner Intervention
•   Home visits, well and sick care
•   Coordination of appointments
•   Individualized health care plan
•   Community services:
    – Social services
    – Social security, insurance
    – Education
       Local Parent Consultants

•   Peer Support
•   Resource Guidance
•   PACC Newsletter
•   Special Activities
    – family dinners
    – computer training
    Individualized Health Plan

• Document for Family and Caregivers
• Summary of Medical Information
     Individualized Health Plan
• Contact Information   •   Routine Therapies
• Insurance             •   Equipment/Supplies
  Information
                        •   School Information
• Primary Diagnosis
                        •   Other Contacts
• Medications
• Allergies             •   Narrative History
• Consultants           •   Review of Systems
• Hospitalizations      •   Family-Centered
• ER visits                 Goals
  Continuing Medical Education

• For N.P.s and M.D.s Semi-Annually
• Relevant Topics
  – Tracheostomy
  – Feeding issues
  – Spasticity management
• Opportunity to Share Information
       Enrollment Process

• MD/NP Caseload Review
• Applied Enrollment Criteria
    – Meet 1 of 9 criteria
•   Prioritized 30 Based on Need
•   Letter of Invitation
•   Home Visit and Informed Consent
•   Baseline Family Surveys Completed
       Criteria for Selection
            Medical Criteria
1.   Biologically based health problem
     involving more than one system
2.   Severe single system disorder
3.   Simultaneous involvement with more
          than one MD specialist
4.   >3 hospitalizations in the prior year
     or a hospitalization that lasted
     greater than 15 days
        Criteria for Selection
          Medical Criteria
5.   Dependence on medical technology for
     survival
6.   Dependence on manual/power
     wheelchair
7.   On-going need for home or school-based
     services
     • home health aides, visiting nurse, block nursing
     • speech, OT, PT
     • other
       Criteria for Selection
         Medical Criteria
8.   For children under 3, early
     intervention for biologic risks and/or
     developmental impairment
9.   Great difficulty in coordinating
     treatment and rehabilitation due to
     the complexity of child’s care
Prevalence of CSHCN by
   Various Definitions

       6%     Mod/sev functional limitations

    13%          MCHB definition
                 (SLAITS)
  30%               Any occurrence
      Characterization of
      Children in PACC
Physician’s Severity Ratings(n=154)

                  10%




                                 mild (n=15)
47%
                                 mod. (n=67)

                                 severe (n=72)
                         43%
Characterization of
Children in PACC
Number of Conditions(n=151)

        6%
  13%
                              >five
                              five
9%                            four
                  48%
                              three
                              two
 15%                          one

        9%
                Parents’ Work Missed

    35
    30
    25

%   20
                                                     Pre
    15                                               Post
    10
    5
    0
         None     1 to 3   4 to 9   10 to 20   >20
            Emergency Visits
50
45
40
35
30
25                                           Pre
20                                           Post
15
10
 5
 0
     None    One to Five   Six-Nine   >=10
            Hospitalizations
60

50

40

30                                             Pre
                                               Post
20

10

0
     None     One-two   Three-five   Six-Ten
  Improvement in Care
Same nurse to talk to     68.4 %
Letters of Medical Need   66.9 %
Early medical care        61.4 % (age)
Phone calls returned      61.2 %
Getting appointments      60.9 %
Communicate with MD       60.9 %
Referrals to MDs          60.5 %
  Improvement in Care
Resources for my child    59.7 %
Relationship with MD      58.3 % (race)
Understand condition      56.2 % (age)
Prescriptions filled      56.0 %
Setting goals for child   51.8 %
Respite Care              23.0 % (race)
Getting transportation    16.5 %
  Sa
     m




                 10
                 20
                 30
                 40
                 50
                 60
                 70
                 80
                 90
                100




                  0
       eR
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 Ea tte
   rly rs
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   on are
     ec
         al
     Ap ls
  R pt
    ef s
 R erra
   es ls
U our
 nd c
    er es
      st
        an
            d
         R
           xs
      G
        o
    R als
      e
 Tr spi
    an te
       sp
                            Involvement




          or
            t
                        Differences by Nurse



                 Low
                 High
                  Response by Race
 Transport
   Respite
     Goals
       Rxs
Understand
 MD relat.
Resources                                   White
 Referrals                                  Non-white
  Talk MD
     Appts
Phone calls
Early Care
   Letters
 Same RN


              0   20   40   60   80   100

				
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posted:9/1/2012
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