PDF  Print  E-mail Link Care Coordinators Help Improve Access to Services for Special Needs Children By Thomas Cheetham, MD Former Medical Director, Orange Grove Center For more than 15 years, the medical home model has provided accessible, coordinated, comprehensive, and culturally appropriate care. Poverty is considered a risk factor for poor health, and having a disability is strongly associated with many barriers to health care, including fewer preventative services. In addition, patients with disabilities often present with complex health issues, which require additional services. Children and adolescents from low-income and/or low-literacy families with special health care needs due to physical or developmental disabilities face even greater challenges accessing health care services. The Arlington Pediatric Center innovation, Pediatric Center Offers Coordinated, Culturally Appropriate Services in a Medical Home, Leading to Increased Access to Comprehensive Care for Low-Income Children With Special Health Care Needs, offers an exciting approach to improving care for this often overlooked population. Intervening in childhood may lead to better long-term health, enhanced quality of life, and lower health care costs. Care coordination is a central aspect of the innovation and part of a team approach to providing comprehensive, culturally appropriate care. Two care coordinators were assigned to the 58 children identified as likely to benefit from the innovation from a total of 2,400 children served by the Arlington Pediatric Center in northern Virginia. The role of the care coordinators was to book appointments, arrange transportation, attend appointments with specialists, obtain needed medical equipment, and coordinate care with schools and early intervention services. There was a patient education component as well. Research has demonstrated that patients retain only a fraction of the information from a medical encounter.1-4 Care coordinators, by accompanying the patients to appointments and using their nursing knowledge in the role of patient educator, helped increase the patient’s understanding of medical issues and treatments. The innovation raises questions that may be answered when the program is adopted and replicated by others. For example, are there data to show that care coordination leads to improved adherence to treatment regiments? How does a program define children “severely affected” by special health care needs? Would an expanded program provide economies of scale that would further reduce costs? The author clearly identifies community support as an essential element to this approach. I suggest that adoption of this innovation include funding for data collection to measure outcomes and determine the program’s effectiveness. References 1 Roter DL. The outpatient medical encounter and elderly patients. Clin Geriatr Med. 2000;16:95-107. [PubMed] 2 Rost K, Roter D. Predictors of recall of medication regimens and recommendations for lifestyle change in elderly patients. Gerontologist. 1987;27:510-5. [PubMed] 3 Crane JA. Patient comprehension of doctor-patient communication on discharge from the emergency department. J Emerg Med. 1997;15:1-7. [PubMed] 4 Bertakis KD. The communication of information from physician to patient: a method for increasing patient retention and satisfaction. J Fam Pract. 1977;5:217-22. [PubMed] Disclosure Statement: Dr. Cheetham has not indicated whether he has financial interests or business/professional affiliations relevant to the work described in this article.

Original publication: July 06, 2009.
Original publication indicates the date the profile was first posted to the Innovations Exchange.

Last updated: May 01, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.

Date verified by innovator: July 20, 2012.
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