Academic journal article Online Journal of Issues in Nursing

Pediatric Care Coordination: Lessons Learned and Future Priorities

Academic journal article Online Journal of Issues in Nursing

Pediatric Care Coordination: Lessons Learned and Future Priorities

Article excerpt

Current healthcare reform efforts are guided by the Institute for Healthcare Improvement (IHI) Triple Aim: improved health, improved experience of care, and reduced cost (IHI, 2015). The evocative title of a recent American Nurses Association (ANA) book, "Care Coordination: The Game Changer: How Nursing is Revolutionizing Quality Care" (Lamb, 20141 recognizes the growing body of convincing evidence that care coordination is an effective IHI Triple Aim strategy. Dr. Lamb states: "Care coordination....is the glue that makes the healthcare system a safe and coherent place" (p. xvi).

Children are especially in need of coordinated comprehensive family-centered care because of their "developmental trajectory, dependency on adults, differential epidemiology of chronic disease, demographic patterns of poverty and diversity, and overall dollars" American Academy of Pediatrics. 2014, p. el452). an important aspect of the state's nation-leading 2008 health reform law, and is driven by the IHI Triple Aim (Minnesota Department of Health fMDHI, 2013b; MDH, 2014; IHI, 2015). This article describes two pediatric care coordination models in Minnesota, a state with a long record of innovation and top-of-the nation population health outcomes. The overriding goal of these models is enhancement of care coordination within a child's medical neighborhood which includes the HCH, using tailored care coordinator roles and functions. In both models, the nurse is a key driver of care coordination success, in partnership with the care coordination team. Underlying the success of these models is the nursing profession's core standard and competency of patient-centered care coordination (American Nurses Association. 2012T

Health Reform in Minnesota

Interest and momentum for Minnesota's HCH began in the mid-1990s when the state committed to the family-centered pediatric medical home model, where the care team partners with the child and family to achieve overall health by addressing both medical and non-medical needs (Ad Hoc Task Force on Definition of the Medical Home, 1992; American Academy of Pediatrics. 2014; National Center for Medical Home Implementation, n.d.: Sia, Tonniqes. Osterhus, &Taba, 2004T Motivation to establish a HCH initiative emerged from compelling testimony by Minnesota parents, based on their experiences receiving patient-centered coordinated care. Other driving factors were reduced hospital admissions and increased dental and well visits, based on analysis of Minnesota Medicaid claims data. Over the next decade (see Figure IT a committed group of consumers, primary care providers, legislators and MDH and Department of Human Services (DHS) personnel brought the HCH model to reality with passage of the state's health reform law in May 2008 (MDH. 2014).

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A major goal of the HCH design was a transparent, public-private collaboration that utilized multi-stakeholder groups and local and national health reform experts. The Institute for Clinical Systems Improvement (ICSI) helped form HCH performance outcome measures for use in evaluating applicants for HCH certification (Institute for Clinical Systems Improvement, n.d.). An assessment of Minnesota provider and patient readiness for HCH guided capacity building efforts (MDH, 2013aT A community engagement and input process supported by the Robert Wood Johnson Foundation included multi-stakeholder groups and experts who formulated the resulting HCH program (see Figure 1). HCH standards and criteria (MDH, 2009) are based on the Chronic Care Model (Improving Chronic Illness Care , 2015; Wagner, 1998) and other literature/expert advice. The voluntary HCH certification process began in 2010 and is an ongoing quality improvement process that includes achievement of 67 criteria over three years (Minnesota Department of Health. 2013b). The goal of certifying 67% of Minnesota's primary care clinics serving Minnesotans by the end of 2015 is well underway, with 383 (53%) certified as of June 2015 (MDH, n. …

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