Enhancing State Medical Home Capacity through a Care Coordination Technical Assistance Model
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Enhancing State Medical Home Capacity through a Care Coordination Technical Assistance Model Susan Berry1,2 · Patti Barovechio1,2 · Emily Mabile1,2 · Tri Tran1,2
© Springer Science+Business Media, LLC 2017
Abstract Introduction A practice-based care coordination (CC) model was developed by Louisiana’s Title V Children’s Special Health Services (CSHS) program to meet the overwhelming needs of the New Orleans post-Katrina population. The pilot clinic demonstrated an improvement in medical home (MH) capacity over the course of 3 months. The purpose of the current study is to evaluate the replicability of the model and sustainability of MH improvement over at least 2 years, while identifying factors that may modify the effect of the intervention. Methods The CSHS CC model utilizing a practice based care coordinator was implemented in 15 academic primary care pediatric clinics. Increase in MH capacity was determined using the MH Index-Short Version (MHI-SV) tool. Results The analysis of the MHI-SV scores for the ten clinics with >2 years of data demonstrated a significant improvement with each of the ten MHI-SV indicators. The mean clinic MHI-SV score improved from 19.70 to 34.15 on a scale of 10–50. Characteristics associated with the greatest MHI score improvement were rural geographic location, having an electronic health record, and using social workers or nurses as care coordinators. Characteristics associated with lower MHI scores were physician or care coordinator turnover and using stand-alone databases rather than tracking CC activities within the central patient record. Conclusion * Susan Berry [email protected] 1
Department of Pediatrics, Louisiana State University Health Science Center, Children’s Hospital of New Orleans, 200 Henry Clay Avenue, New Orleans, LA 70118, USA
2
Title V Children and Youth with Special Health Care Needs Programs, Bureau of Family Health, Office of Public Health, Louisiana Department of Health, Louisiana Office of Public Health, New Orleans, LA 70112, USA
This study provides a flexible framework for implementing CC services in pediatric, family medicine, and medicinepediatric practices, and demonstrates the value of CC as a driver for improvement in medical home capacity. Keywords Patient-centered care · Medical home · Care coordination · Patient-focused care · Primary health care Abbreviations CYSHCN Children and youth with special health care needs MCHB Maternal and Child Health Bureau CC Care coordination CSHS Children’s Special Health Services PCMH Patient-centered medical home NICHQ National Initiative for Child Health Quality MHI-SV Medical Home Index-Short Version CAHMI Child and Adolescent Health Measurement Initiative LSUHSC Louisiana State University Health Sciences Center MCO Managed care organization QI Quality improvement
Significance What is known on this subject? Practice-based care coordination (CC) is more effective than agency based CC for CYSHCN, however, replicable models for integrating CC into a busy primary care practice are lackin
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