Ensuring access to pediatric subspecialists for vulnerable children

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 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.