Pediatric Medical Home Care Coordination

Abstract

Background: Socioeconomic and social complexities are associated with delays in children receiving a timely evaluation for behavioral health treatment and developmental delays. The American Academy of Pediatrics recognizes the complex needs of these children and the key role of primary care providers in the referral process and care coordination to ensure the timely start of services and treatment. This recommendation is also supported by the Individual and Disability Education Act Part C, that requires children identified with developmental delays to be evaluated for services within 45 days of referral. Local Problem: The purpose of this QI project was to evaluate and implement the care coordination of children referred for early intervention services and behavioral health treatment at a primary care practice in the Mid-Atlantic Region. Interventions: The Care Coordination Measurement Tool was approved by Dr. Antonelli at Boston Children’s Hospital and implemented to quantitatively measure care coordination tasks completed during the 12-week project timeline. The tool was used to track the volume of referrals sent, care plans and consults received, and communication that occurred between providers and specialists. During project implementation, the electronic medical record at the project site received a system upgrade, allowing for real-time interface and data exchange with specialists. This system upgrade allowed for referrals to be sent and care plans to be received electronically. Results: An overall 14-day reduction from referral to evaluation for both behavioral health and early intervention services, and a 16-day reduction for children referred for delayed speech was achieved. The pre-project mean (37.0) for days to evaluation vs. project mean (22.8) was shown to be statistically significant using an alpha of 0.05 and a two-independent sample T-test with unequal variance. Data outliers included maternal drug history and parents not responding to early intervention services. The care coordination tool captured a total of more than 200 care coordination needs, activities, and outcomes over the 12-week project timeline. Over 70 care plans-consults were received through electronic interface, and staff completed greater than 13 behavioral health paper forms. Conclusions: The role of the electronic medical record in primary care can reduce the average number of days from referral to evaluation, improving patient outcomes. Collaboration and communication among specialists and providers will also improve as care plans and consult reports are received electronically. These findings indicate that the communication feedback loop was completed, as referrals were sent, evaluations were completed, services were started, and patient care plans were received.