Browsing by Subject "care coordination"

Now showing 1 - 5 of 5
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    Assessing public behavioral health services data: a mixed method analysis
    (BMC, 2020-11-11) Vaughn, Sierra X.; Maxey, Hannah L.; Keen, Alyson; Thoele, Kelli; Newhouse, Robin; Medicine, School of Medicine
    Background Measuring behavioral health treatment accessibility requires timely, comprehensive and accurate data collection. Existing public sources of data have inconsistent metrics, delayed times to publication and do not measure all factors related to accessibility. This study seeks to capture this additional information and determine its importance for informing accessibility and care coordination. Methods The 2018 National Survey for Substance Abuse and Treatment Services (N-SSATS) data were used to identify behavioral health facilities in Indiana and gather baseline information. A telephone survey was administered to facilities with questions parallel to the N-SSATS and additional questions regarding capacity and patient intake. Quantitative analysis includes chi-square tests. A standard qualitative analysis was used for theming answers to open-ended questions. Results About 20% of behavioral health facilities responded to the study survey, and non-response bias was identified by geographic region. Among respondents, statistically significant differences were found in several questions asked in both the study survey and N-SSATS. Data gathered from the additional questions revealed many facilities to have wait times to intake longer than 2 weeks, inconsistency in intake assessment tools used, limited capacity for walk-ins and numerous requirements for engaging in treatment. Conclusion Despite the low response rate to this study survey, results demonstrate that multiple factors not currently captured in public data sources can influence coordination of care. The questions included in this study survey could serve as a framework for routinely gathering these data and can facilitate efforts for successful coordination of care and clinical decision-making.
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    Care Coordination for Children With Medical Complexity: Whose Care Is It, Anyway?
    (AAP, 2018-03) Kuo, Dennis Z.; McAllister, Jeanne W.; Rossignol, Lisa; Turchi, Renee M.; Stille, Christopher J.; Pediatrics, School of Medicine
    Children with medical complexity (CMC) have multiple chronic conditions and require an array of medical- and community-based providers. Dedicated care coordination is increasingly seen as key to addressing the fragmented care that CMC often encounter. Often conceptually misunderstood, care coordination is a team-driven activity that organizes and drives service integration. In this article, we examine models of care coordination and clarify related terms such as care integration and case management. The location of care coordination resources for CMC may range from direct practice provision to external organizations such as hospitals and accountable care organizations. We discuss the need for infrastructure building, design and implementation leadership, use of care coordination tools and training modules, and appropriate resource allocation under new payment models.
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    Family-Centered Care Coordination in an Interdisciplinary Neurodevelopmental Evaluation Clinic: Outcomes From Care Coordinator and Caregiver Reports
    (Frontiers, 2020-10) McNally Keehn, Rebecca; Enneking, Brett; Ramaker, Margo; Goings, Michael; Yang, Ziyi; Carroll, Aaron; Ciccarelli, Mary; Pediatrics, School of Medicine
    Children with neurodevelopmental disabilities experience many unmet healthcare needs. Care coordination is one critical solution to addressing the substantial strain on families, local communities, and the larger healthcare system. The purpose of this study was to implement a care coordination program in an interdisciplinary pediatric neurodevelopmental evaluation clinic and examine care coordinator and caregiver outcomes. Following neurodevelopmental diagnosis, children were provided with either care coordination (CC) or care as usual (CAU). For those receiving CC, the care coordinator documented family goals and care coordination activities, outcomes, and time spent. Caregivers in both groups completed a survey measuring access to needed services and caregiver stress and empowerment following their child's evaluation (T1) and 4-6 months post-evaluation (T2). Care coordinator findings demonstrated that over 85% of family goals focused on understanding the child's diagnosis, getting needed interventions and educational support, and accessing healthcare financing programs. More than half of care coordination activities were spent on engaging and educating the family; similarly, the most time-consuming care coordination efforts were in helping families understand their child's diagnosis and meeting family's basic needs. For those children referred to needed services, 54% were enrolled in one or more service at T2. Caregivers in both the CC and CAU groups reported an increase in stress related to interactions with their child as well as increased empowerment from T1 to T2. Contrary to our hypotheses, there were no significant group-by-time interactions across caregiver-report measures. While these findings further our understanding of care coordination delivery, they diverge from previous evidence demonstrating care coordination efficacy. This study paves the way for future opportunities to evaluate what kinds of care coordination supports family need at varying times in their child's healthcare journey and how the outcomes important to all stakeholders are measured to reflect true evaluation of efficacy.
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    Response to depression treatment in the Aging Brain Care Medical Home model
    (Dove Medical Press, 2016) LaMantia, Michael A.; Perkins, Anthony J.; Gao, Sujuan; Austrom, Mary G.; Alder, Cathy A.; French, Dustin D.; Litzelman, Debra K.; Cottingham, Ann H.; Boustani, Malaz A.; Department of Biostatistics, School of Public Health
    OBJECTIVE: To evaluate the effect of the Aging Brain Care (ABC) Medical Home program's depression module on patients' depression severity measurement over time. DESIGN: Retrospective chart review. SETTING: Public hospital system. PARTICIPANTS: Patients enrolled in the ABC Medical Home program between October 1, 2012 and March 31, 2014. METHODS: The response of 773 enrolled patients who had multiple patient health questionnaire-9 (PHQ-9) scores recorded in the ABC Medical Home program's depression care protocol was evaluated. Repeatedly measured PHQ-9 change scores were the dependent variables in the mixed effects models, and demographic and comorbid medical conditions were tested as potential independent variables while including random effects for time and intercept. RESULTS: Among those patients with baseline PHQ-9 scores >10, there was a significant decrease in PHQ-9 scores over time (P<0.001); however, the effect differed by gender (P=0.015). On average, women's scores (4.5 point drop at 1 month) improved faster than men's scores (1 point drop at 1 month). Moreover, both men and women had a predicted drop of 7 points (>50% decline from baseline) on the PHQ-9 at 6 months. CONCLUSION: These analyses demonstrate evidence for the sustained effectiveness of the ABC Medical Home program at inducing depression remission outcomes while employing clinical staff who required less formal training than earlier clinical trials.
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    Three Essays in Health Economics: The Role of Coordination in Improving Outcomes and Increasing Value in Health Care
    (2022-06) Sheff, Zachary Thompson; Ottoni-Wilhelm, Mark; Royalty, Anne; Tennekoon, Vidhura; Morrison, Gwendolyn; Dixon, Brian E.
    Hospital costs are the largest contributor to US health expenditures, making them a common target for cost containment policies. Policies that reduce fragmentation in health care and related systems could increase the value of these expenditures while improving outcomes. Efforts to address fragmentation of health care services, such as Accountable Care Organizations, have typically been enacted at the scale of health systems. However, coordination within health care facilities should also be explored. In three essays, I analyze the role of coordination in several forms. First, I examine the introduction of interdisciplinary care teams within a hospital. This analysis features care coordination within a health care facility with the potential to reduce resource utilization through improved communication between team members and between patients and their care providers. I find that care coordination reduced length of stay for some patients while maintaining care quality. This combination results in higher value care for patients and hospitals. Second, I explore whether these interdisciplinary care teams impact resource utilization and patient flow throughout the hospital. The primary outcome is reduction in patient transfers to the ICU. Here, care coordination includes interdisciplinary teams as well as coordination between interdisciplinary teams and intensivists in ICUs. Findings from this analysis suggest that ICU transfers were unaffected by care coordination. Finally, I examine coordination on a larger scale. I leverage data from a national database of trauma patients to compare mortality among adolescent patients with isolated traumatic brain injury between adult trauma centers and pediatric trauma centers. Previous work has shown that younger pediatric patients with this injury benefit from treatment at pediatric trauma centers. However, it is unclear whether this benefit extends to older pediatric patients on the cusp of adulthood. I find that, after adjusting for differences in injury severity, adolescent patients have no difference in mortality risk when treated at adult or pediatric trauma centers. This finding supports the current regionalized model of trauma care where severely injured patients are taken to the nearest trauma center, regardless of designation as pediatric or adult.