Enhancing the quality of care coordination for children with special needs: Results from the Jacksonville Medical Home Project

Children with special health care needs (CSHCN) are a heterogeneous population representing hundreds of chronic illnesses, disabilities, and/or mental health conditions. In addition to primary and specialty medical care, CSHCN and their families may receive educational, developmental and support services tied to a variety of funding agencies. As they navigate this maze of programs they may experience multiple barriers to services, increasing the potential to fall through the cracks. Care coordination, particularly when provided from within a Medical Home, is thought to enhance the utilization of, and satisfaction with, services provided to CSHCN and their families. This presentation describes results from the Jacksonville Medical Home Project, a mixed-method prospective cohort study of a Medical Home intervention for Florida Title V-CSHCN receiving care from 3 intervention and 3 control practices (n=262, baseline) in Jacksonville, Fl. The co-location of a Title-V nurse care coordinator (NCC) was central to the intervention design, which also included physician/NCC training on the Medical Home philosophy, and regular quality improvement meetings with staff. Quantitative results indicate significant improvement among participants in intervention sites in care coordination, including experience w/care coordination (p=.02), satisfaction w/care coordination services (p=.03), and barriers to health services (p < .01). Qualitative results suggest that improvements in care coordination reported by the intervention group follow from the co-location of the NCC in the pediatric practice and the concomitant improvements in access, communication, and follow-up experienced by families, NCCs, and pediatricians. These results are discussed in the context of policy implications for Florida Title V-CSHCN.