A tertiary care-primary care partnership model for medically complex and fragile children and youth with special health care needs. Arch Pediatr Adolesc Med 2007 Oct;161(10):937-44
Date
10/03/2007Pubmed ID
17909136DOI
10.1001/archpedi.161.10.937Scopus ID
2-s2.0-34948888898 (requires institutional sign-in at Scopus site) 191 CitationsAbstract
OBJECTIVE: To evaluate the impact of a tertiary care center special needs program that partners with families and primary care physicians to ensure seamless inpatient and outpatient care and assist in providing medical homes.
DESIGN: Up to 3 years of preenrollment and postenrollment data were compared for patients in the special needs program from July 1, 2002, through June 30, 2005.
SETTING: A tertiary care center pediatric hospital and medical school serving urban and rural patients.
PARTICIPANTS: A total of 227 of 230 medically complex and fragile children and youth with special needs who had a wide range of chronic disorders and were enrolled in the special needs program.
INTERVENTIONS: Care coordination provided by a special needs program pediatric nurse case manager with or without a special needs program physician.
MAIN OUTCOME MEASURES: Preenrollment and postenrollment tertiary care center resource utilization, charges, and payments.
RESULTS: A statistically significant decrease was found in the number of hospitalizations, number of hospital days, and tertiary care center charges and payments, and an increase was found in the use of outpatient services. Aggregate data revealed a decrease in hospital days from 7926 to 3831, an increase in clinic visits from 3150 to 5420, and a decrease in tertiary care center payments of $10.7 million. The special needs program budget for fiscal year 2005 had a deficit of $400,000.
CONCLUSION: This tertiary care-primary care partnership model improved health care and reduced costs with relatively modest institutional support.
Author List
Gordon JB, Colby HH, Bartelt T, Jablonski D, Krauthoefer ML, Havens PMESH terms used to index this publication - Major topics in bold
AdolescentAge Factors
Case Management
Child
Child, Preschool
Cooperative Behavior
Female
Health Services Needs and Demand
Hospitals, Pediatric
Humans
Interinstitutional Relations
Interprofessional Relations
Male
Models, Organizational
Patient Care Team
Primary Health Care
Rural Health Services
Time Factors
Urban Health Services
Wisconsin
