Online Program

Ensuring access to pediatric subspecialists for vulnerable children

Monday, November 4, 2013

Adejoke Ogunrinde, MBBS, Children's Health Fund, New York, NY
Maria Scigliano, MS/MSW, Children's Health Fund, New York, NY
Randy Christensen, MD, Phoenix Children's Hospital, Phoenix Children's Health Project, Phoenix, AZ
Delaney Gracy, MD, MPH (Epidemiology), Medical Affairs, Children's Health Fund, New York, NY
Lara Yoblonski, MD, Phoenix Children's Health Project, Phoenix, AZ
Virginia Roncaglione, MSc, Medical Affairs, Children's Health Fund, New York, NY
Among medically underserved children, there is a high incidence of chronic and acute conditions that may go underdiagnosed and/or undertreated. Families in these communities often have difficulty accessing needed subspecialty care. Multiple access barriers exist including lack of insurance, poor coverage, provider reimbursement issues and shortages of specialists. Geographic proximity is an important factor that affects access. At least 3 million children nationally miss health care appointments annually because they lack affordable transportation. The Referral Management Initiative (RMI) is designed to alleviate barriers that prevent children from receiving subspecialist services and to improve continuity of care. It operates in three cities, Dallas, Phoenix and New York. Each program serves a predominantly minority pediatric population including homeless children and youth. The main components of RMI are appointment reminders; transportation arrangements; help navigating the health care system; management of communication among patient, referring provider and specialist; and tracking referral outcomes. A past study has shown that with RMI, adherence with medical subspecialty appointments among a vulnerable patient population of homeless children in shelters increased from 7% to 61%. We will present current data from one of the three above-mentioned programs that describe the efficacy of this referral management initiative and discuss some of the clinical issues that were addressed. RMI contributes to community health centers ability to close the loop in specialty referrals and meet standards for NCQA recognition as a Patient Centered Medical Home.

Learning Areas:

Advocacy for health and health education
Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public
Public health or related public policy

Learning Objectives:
List the components of a functional Referral Management Initiative Assess the burdens and benefits of access to subspecialty care Describe the importance of coordinating transportation resources to improve health care access

Keyword(s): Underserved Populations, Access and Services

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the manager of several grants pertaining to improving child health and access to care. Among my interests are developing strategies to reduce barriers to care and improve access to care for children in need.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.