Department of Pediatrics, Louisiana State University Health Sciences Center, 1010 Common Street Suite #610, New Orleans, LA 70112, USA.
Matern Child Health J. 2011 Aug;15(6):782-93. doi: 10.1007/s10995-010-0641-4.
This is a prospective study to evaluate ability of a nurse care coordinator to: (1) improve ability of a pediatric clinic to meet medical home (MH) objectives and (2) improve receipt of services for families of children with special health care needs (CSHCN). A nurse was hired to provide care coordination for CSHCN in an urban, largely Medicaid pediatric academic practice. CSHCN were identified using a CSHCN Screener. Ability to meet MH criteria was determined using the MH Index (MHI). Receipt of MH services was measured using the MH Family Index (MHFI). After baseline surveys were completed, Hurricane Katrina destroyed the clinic. Care coordination was implemented for the post-disaster population. Surveys were repeated in the rebuilt clinic after at least 3 months of care coordination. The distribution of demographics, diagnoses and percent CSHCN did not significantly change pre and post Katrina. Psychosocial needs such as food, housing, mental health and education were markedly increased. Essential strategies included developing a new tool for determining complexity of needs and involvement of the entire practice in care coordination activities. MHFI showed improvement in receipt of services post care coordination and post-Katrina with P < 0.05 for 13 of 16 questions. MHI demonstrated improvement in care coordination and community outreach domains. Average cost was $36.88 per CSHCN per year. There was significant improvement in the ability of the clinic to meet care coordination and community outreach MH criteria and in family receipt of services after care coordination, despite great increase in psychosocial needs. This study provides practical strategies for implementing care coordination for families of high risk CSHCN in underserved populations.
这是一项前瞻性研究，旨在评估护士护理协调员的能力：（1）提高儿科诊所满足医疗之家（MH）目标的能力，（2）改善有特殊健康护理需求的儿童（CSHCN）家庭获得服务的机会。在一家城市、主要由医疗补助计划（Medicaid）覆盖的儿科学术实践中，聘请了一名护士为 CSHCN 提供护理协调。使用 CSHCN 筛查器来识别 CSHCN。使用医疗之家指数（MHI）来确定满足 MH 标准的能力。使用 MH 家庭指数（MHFI）来衡量 MH 服务的获得情况。完成基线调查后，卡特里娜飓风摧毁了诊所。为灾后人群实施了护理协调。在护理协调至少 3 个月后，在重建的诊所中重复进行调查。在卡特里娜飓风前后，人口统计学特征、诊断和 CSHCN 的百分比分布没有显著变化。食品、住房、心理健康和教育等心理社会需求明显增加。关键策略包括开发一种新工具来确定需求的复杂性，并让整个实践参与到护理协调活动中。MHFI 显示，在护理协调后和卡特里娜飓风后，服务的获得有所改善，16 个问题中有 13 个问题的 P 值<0.05。MHI 在护理协调和社区外联领域表现出改善。平均成本为每个 CSHCN 每年 36.88 美元。尽管心理社会需求大幅增加，但诊所满足护理协调和社区外联 MH 标准的能力以及家庭获得服务的能力有了显著提高。这项研究为在服务不足的人群中为高风险 CSHCN 的家庭实施护理协调提供了实用策略。
