A Nationally Representative Study of Care Coordination in Pediatric Healthcare

Background and Purpose:

Care coordination involves organizing patient care activities and improving communication among healthcare providers in order to improve adherence to a care plan. Heavily promoted by the Patient Protection and Affordable Care Act, care coordination is vital to integrated care strategies aimed at improving patient safety and quality of care for vulnerable populations with overlapping health and psychosocial needs. One target group for care coordination is children with special healthcare needs and their parents. However, we know little about who is receiving care coordination in the pediatric population. Additionally, care coordination as a service aligns seamlessly with social work values, ethics, and scope and is an emerging future area of social work practice. The purpose of this study is to identify what factors are related to receipt of care coordination among pediatric patients using a nationally representative sample.

Methods:

The 2011/2012 National Survey of Children’s Health (n=95,677) was used to estimate the caregiver-reported receipt of pediatric care coordination in the United States among children engaged in the health care system. The second aim of the study was to identify factors related to receipt of pediatric care coordination. Predisposing factors (e.g., child and family demographic characteristics), enabling factors (e.g., income, insurance type, medical home), and need factors (e.g., health status) were explored. Logistic regression integrating survey weights was used to predict receipt of care coordination.

Results:

Only 20.5% of caregivers of children in the U.S. engaged in healthcare services reported receiving care coordination. Children with special healthcare needs and caregivers who reported a need for care coordination were more likely to receive  care coordination. However, there was a high rate of unmet need among these groups. Children of single mothers had lower odds of receiving care coordination (OR=0.75) than two-parent households. Newborns and infants were most likely to receive care coordination compared to older children and adolescents. Hispanic children (OR=1.08) and black children (OR=1.02) were slightly more likely to receive care coordination when compared to White children. Similarly, children living in primarily non-English-speaking households are at significantly higher odds of receiving care coordination than those in primarily English-speaking homes (OR=1.76). Uninsured children (OR=0.78) receive less care coordination and children with private health insurance (OR=1.04) were more likely to receive care coordination compared to those with public insurance (Medicaid or SCHIP).

Conclusion and Implications:

These findings have critical importance for policy and practice. The benefits of care coordination are likely to impact special needs, minority, impoverished, under- or uninsured, and medically underserved children. Findings indicate that this clinical need is not being met despite caregiver-reported desire for help with coordinating healthcare services. Moreover, due to changing billing structures subsequent to the Patient Protection and Affordable Care Act, the importance of preventative and integrated services such as care coordination are further increased. These results inform a greater need for social work coordinated care in the medical setting and call for increased attention to and emphasis on high-risk populations.