Meeting the Needs of Children with Medical Complexity Using a Telehealth Advanced Practice Registered Nurse Care Coordin
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Meeting the Needs of Children with Medical Complexity Using a Telehealth Advanced Practice Registered Nurse Care Coordination Model Rhonda G. Cady • Mary Erickson • Scott Lunos Stanley M. Finkelstein • Wendy Looman • Margaret Celebreeze • Ann Garwick
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Ó Springer Science+Business Media New York 2014
Abstract Effective care coordination is a key quality and safety strategy for populations with chronic conditions, including children with medical complexity (CMC). However, gaps remain in parent report of the need for care coordination help and receipt of care coordination help. New models must close this gap while maintaining family-centered focus. A three-armed randomized controlled trial conducted in an established medical home utilized an advanced practice registered nurse intervention based on Presler’s model of clinic-based care coordination. The model supported families of CMC across settings using telephone only or telephone and video telehealth care coordination. Effectiveness was evaluated from many perspectives and this paper reports on a subset of outcomes that includes family-centered care (FCC), need for care coordination help and adequacy of care coordination help received. FCC at baseline and end of study showed no significant difference between groups. Median FCC scores of 18.0–20.0 across all groups indicated high FCC within the medical home. No significant differences were found in the need for care coordination help within or between groups and over time. No significant difference was found in the adequacy of help received between groups at baseline. However, this indicator R. G. Cady S. Lunos S. M. Finkelstein W. Looman M. Celebreeze A. Garwick University of Minnesota, 420 Delaware Street SE, MMC 609, Minneapolis, MN 55455, USA R. G. Cady (&) Gillette Children’s Specialty Healthcare, St. Paul, Minnesota, USA e-mail: [email protected] M. Erickson Children’s Hospitals and Clinics of Minnesota, Minneapolis, MN, USA
increased significantly over time for both intervention groups. These findings suggest that in an established medical home with high levels of FCC, families of CMC have unmet needs for care coordination help that are addressed by the APRN telehealth care coordination model. Keywords Care coordination Children with medical complexity Family-centered care Advance practice registered nurse Telehealth Medical home
Introduction The recommended approach for primary care of all children is the medical home [1]. Care coordination is an essential component of this model [2, 3] and a key quality and safety strategy for populations with chronic conditions [4–7]. The Maternal Child Health Bureau defines care coordination as, ‘‘a process that links children with special health care needs and their families to services and resources in a coordinated effort to maximize the potential of children and provide them with optimal health care’’ [8]. Children with medical complexity (CMC) [9] have chronic conditions involving multiple body systems, multiple service provide
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