Tuesday, November 6, 2007

This presentation is part of : Caring for Children with Special Healthcare Needs
Factors Influencing Care Coordination in Children with Special Healthcare Needs
Brenda M. Holtzer, PhD, RN, Nursing, Children's Hospital of Philadelphia, Philadelphia, PA, USA
Learning Objective #1: identify the factors influencing which Children with Special Health Care Needs receive care coordination services.
Learning Objective #2: examine the effects of care coordination by comparing select outcomes of care for chronically ill children.

Children with Special Health Care Needs (CSHCN) often require diverse and extensive health care services. There is little evidence for the effectiveness of coordination in reducing costs and improving outcomes in this population. This presentation explores factors leading to parent perceptions of CSHCN needing and receiving care coordination services. It then examined whether these services made a difference relative to outcomes for the children and their families.
            The researcher will present research findings from her dissertation, along with recommendations for nurses working with CSHCN and their families. Data from the National Survey of Children with Special Health Care Needs (NSCSHCN) (2001-2002), and public files for State Title V funding percentages for CSHCN were analyzed in this study.
Older children, having a usual source of care, and poverty level below 200% increased the likelihood of not receiving care coordination, even when controlling for severity of illness and changing needs.  Type of insurance, receiving Title V funding, state generosity, and rural location had no significant effects.  Not receiving care coordination was found to decrease likelihood of having needs met, with the strongest effect for receipt of prescription medications and specialist care.  Likewise, families not receiving care coordination reported significantly lower levels of communication and significantly higher out of pocket expenses.

The study findings suggest that CSHCN receiving Title V and Medicaid are most likely to receive care coordination.  In addition, having a usual source of care is consistent with receiving care coordination.  As funding decreases, CSHCN are likely to enroll and disenroll more often from public programs.  This may influence the continuity and coordination of services and needs to be monitored.  Implications for nursing practice include the need to develop evidence-based practice standards for this essential nursing role, and to advocate for improvements in children’s health care programs.