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Care coordination for children with medical complexity: a mixed-methods evaluation

Eichner, Joan Carpenter (2017) Care coordination for children with medical complexity: a mixed-methods evaluation. Doctoral Dissertation, University of Pittsburgh. (Unpublished)

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In the US and the world, the number of children living with chronic and complex medical conditions is growing. Many also have unmet health needs. While these children are frequent users of high-cost health services, their care is often received in home- and community-based settings, with families assuming responsibility for care management and direct care. Care coordination is part of the recommended standard of care to improve patient outcomes and ensure patient-/family-focused, comprehensive care across service settings for children who have special health care needs.
Living with a child with medical complexity can place psychological, social, and financial strains on a family. It is hypothesized that families at risk of poor outcomes stand to benefit from care coordination, and that care coordination could lead to cost-savings for the health system. Despite growth in the research on care coordination and some evidence of its benefits on health outcomes and costs, substantial variation in definition, implementation, and evaluation remains. This issue has public health significance because care coordination may be an effective strategy to reduce high-cost health services use, prevent unnecessary care, improve the patient/family experience, and ultimately improve patient outcomes.
The goals of this dissertation were to review the literature on key aspects of care coordination for children with special health care needs and their associations with empowerment, assess the implementation of a pilot care coordination program, and use interviews and surveys to explore families’ experiences of care coordination.
As per agency policy, the pilot care coordination program provided tiered support based on medical and psychosocial acuity. Higher-acuity families received more staff contacts and longer contact time. Trends show the majority of families reduced acuity from enrollment to the end of the study period.
Higher-acuity families and families enrolled for a longer period rated the family-centeredness of the care coordination they received higher than those at lower acuity and those in the program for less time. Higher-acuity families self-reported a reduction in emergency department use and hospitalization since enrolling. While there were no significant results on empowerment, families described numerous benefits of care coordination, including: efficiency, legitimacy, support, and stress reduction.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Eichner, Joan Carpenterjce12@pitt.edujce12
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairAlbert, Stevensmalbert@pitt.edusmalbert
Committee MemberElias, Thistleelias@pitt.eduelias
Committee MemberHawk, Marymeh96@pitt.edumeh96
Committee MemberDegenholtz, Howarddegen@pitt.edudegen
Committee MemberMasiello,
Date: 29 June 2017
Date Type: Publication
Defense Date: 6 April 2017
Approval Date: 29 June 2017
Submission Date: 10 March 2017
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 193
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Behavioral and Community Health Sciences
Degree: DrPH - Doctor of Public Health
Thesis Type: Doctoral Dissertation
Refereed: Yes
Uncontrolled Keywords: care coordination, children with medical complexity, family empowerment,
Date Deposited: 29 Jun 2017 23:51
Last Modified: 01 May 2018 05:15


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