Consultative Care Coordination Through the Medical Home for CSHCN: A Randomized Controlled Trial
Consultative Care Coordination Through the Medical Home for CSHCN: A Randomized Controlled Trial
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DOI：
10.1007/s10995-010-0658-8
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发表时间：
2011-10-01
影响因子：
2.3
通讯作者：
Ge, Bin
中科院分区：
文献类型：
--
作者：
Farmer, Janet E.;Clark, Mary J.;Ge, Bin
本研究的目的是探讨护理协调干预的影响，旨在改善医疗之家的儿童有特殊医疗保健需求（CSHCN）。100名由医疗补助管理护理计划转诊的CSHCN被随机分配到护理协调干预组或接受标准护理的等待名单对照组。对于干预组，护理协调员通过与多个实践中的初级保健提供者协商来支持医疗之家，以制定综合的个性化计划，以满足儿童和家庭的需求。在研究的第二阶段，等待名单对照组接受了6个月的干预。在12个月结束时，将两组合并以检查受试者内差异（n = 61）。与对照组相比，初始干预组的参与者报告对信息的需求减少，对心理健康服务和专业治疗的满意度提高。当等待列表控制组接受干预时，这种效果被复制。在受试者内分析中观察到其他益处，包括未满足需求的下降，对专科护理和护理协调的满意度提高，以及儿童健康和家庭功能评分的提高。这种干预措施通过支持初级保健医生通过医疗之家提供全面和协调的护理，改善了CSHCN及其家庭的结果。咨询护理协调员可以提供一个有效的和具有成本效益的方法来提高CSHCN的护理质量。
The purpose of this study was to examine the impact of a care coordination intervention aimed at improving the medical home for children with special health care needs (CSHCN). 100 CSHCN referred by a Medicaid managed care plan were randomly assigned to a care coordination intervention or to a wait list comparison group that received standard care. For the intervention group, a care coordinator supported the medical home by consulting with primary care providers at multiple practices to develop an integrated, individualized plan to meet child and family needs. During the second phase of the study, the wait list comparison group received the 6-month intervention. At the end of 12 months, the two groups were combined to examine within subject differences (n = 61). Compared to the control group, participants in the initial intervention group reported a decreased need for information and improved satisfaction with mental health services and specialized therapies. This effect was replicated when the wait list control group received the intervention. Additional benefits were observed in the within subject analysis, including a decline in unmet needs, improved satisfaction with specialty care and care coordination, and improved ratings of child health and family functioning. This intervention improved outcomes for CSHCN and their families by supporting the efforts of primary care physicians to provide comprehensive and coordinated care through the medical home. The consulting care coordinator may provide an efficient and cost effective approach to enhancing the quality of care for CSHCN.