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Cited by 171Adolescent and Pediatric HealthcarePrimary Care and Health OutcomesHealthcare Systems and Technology

Care Coordination for Children and Youth With Special Health Care Needs: A Descriptive, Multisite Study of Activities, Personnel Costs, and Outcomes

Antonelli, Richard C., Stille, Christopher J., Antonelli, Donna M.·2008·Pediatrics
DOI 10.1542/peds.2007-2254
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Abstract

OBJECTIVES. Objectives included testing use of the care-coordination measurement tool in pediatric primary care practices; describing care-coordination activities for children and youth that occur in primary care practices; assessing the relationship of care-coordination activities in the medical home with outcomes related to resource use; and measuring the direct personnel costs of care-coordination activities. METHODS. Six general pediatric practices were selected, representing a diverse range of sizes, locations, patient demographics, and care-coordination activity model types. The care-coordination measurement tool was used over a period of 8 months in 2003 to record all of the nonreimbursable care-coordination activity encounters performed by any office-based personnel. The tool enabled recording of activities, resources-use outcomes, and time. Cost of personnel performing care-coordination activities was derived by extrapolation from the time spent. RESULTS. Care-coordination activity services were used by patients of all complexity levels. Children and youth with special health care needs with acute-onset, family-based psychosocial problems experienced 14% of the care-coordination activity encounters and used 21% of the care-coordination activities minutes. Children and youth without special health care needs, without complicating family psychosocial problems, received 50% of the encounters and used 36% of the care-coordination activity minutes. The average cost per care-coordination activity encounter varied from $4.39 to $12.86, with an overall mean of $7.78. A principal cost driver seemed to be the percentage of care-coordination activities performed by physicians. Office-based nurses prevented a large majority of emergency department visits and episodic office visits. CONCLUSIONS. Care-coordination activity was assessed at the practice level, and the care-coordination measurement tool was used successfully during the operations of typical, pediatric, primary care settings. The presence of acute, family-based social stressors was a significant driver of need for care-coordination activities. A high proportion of dependence on care-coordination performed by physicians led to increased costs. Office-based nurses providing care coordination were responsible for a significant number of episodes of avoidance of higher cost use outcomes.

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Authors
Antonelli, R. C., Stille, C. J., & Antonelli, D. M.
Affiliations
  • University of Connecticut (US)
  • University of Massachusetts Chan Medical School (US)
  • Lahey Hospital and Medical Center (US)
ORCID
Venue
Pediatrics
Publisher
American Academy of Pediatrics (AAP)
Published
2008-07-01
Volume
122
Issue
1
Pages
e209-e216
ISSN
  • 0031-4005 (ISSN-L)
  • 1098-4275
DOI
10.1542/peds.2007-2254
OpenAlex
W2154214201
Cited by
171
References
12
Citations by year
2026: 4 · 2025: 5 · 2024: 5 · 2023: 5 · 2022: 13 · 2021: 10 · 2020: 9 · 2019: 13 · 2018: 18 · 2017: 6 · 2016: 10 · 2015: 12 · 2014: 13 · 2013: 5 · 2012: 7
FWCI
33.23
Type
journal article
Language
en
Open access
closed
Locations
  • PEDIATRICS (publishedVersion)
  • PubMed (publishedVersion)
  • The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
Funders
U.S. Public Health Service (HRSA-02-MCHB-25A-AB)
Topics
  • Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Healthcare Systems and Technology
Keywords
care coordination, children and youth with special health care needs, pediatric primary care, patient-centered medical home, personnel costs, resource utilization (health care), emergency department visits, physician participation
MeSH terms
Allied Health Personnel, Child, Child, Exceptional, Health Services Needs and Demand, Humans, Patient Care Planning, Pediatrics, Primary Health Care, United States, Disabled Children, Children with Disabilities

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