title: Categorical funding to seamless systems of care: the challenge for community-based primary care providers.
abstract: Integrating categorical funding to design "seamless systems of care" for individual patients is a challenge faced by many local community-based providers. Providers may choose to develop separate site-specific categorical programs for patients with human immunodeficiency virus (HIV) [e.g., specialized treatment site or a homeless clinic] or integrate these programs with their general primary care population. Regardless of program location, providers have developed patterns for finding the most appropriate medical home for a patient with multiple categorical risks. Medical records reviews and patient interviews indicate the importance of case managers in service coordination, although clinical issues appear more readily coordinated than situational ones. Provider dependence solely on case managers for service coordination, across sites and programs may become problematic in the era of managed care without a supportive information system that tracks client use and a records system that integrates clinical and social service notes. Local providers have encountered difficulties in exchanging essential medical information, even within a single agency, under state statutes regarding confidentiality of HIV test results.
authors.affiliation: MDS Associates, Wheaton, MD 20902, USA.
authors.forename: C
authors.initials: C
authors.lastname: Ulmer
authors.forename: D
authors.initials: D
authors.lastname: Lewis-Idema
authors.forename: M
authors.initials: M
authors.lastname: Falik
authors.forename: T P
authors.initials: TP
authors.lastname: Raggio
authors.forename: P
authors.initials: P
authors.lastname: Stoessel
authors.forename: T
authors.initials: T
authors.lastname: Coughlin
authors.forename: D
authors.initials: D
authors.lastname: Butterworth
authors.forename: J
authors.initials: J
authors.lastname: Tillman
mesh_terms: D019090:Case Management / Q000458:organization & administration*; D003153:Community Health Services / Q000458:organization & administration*; D003266:Continuity of Patient Care / Q000458:organization & administration*; D019091:Critical Pathways; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D005381:Financing, Organized; D015658:HIV Infections / Q000628:therapy; D006302:Health Services Research; D006703:Ill-Housed Persons; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D011247:Pregnancy; D018566:Pregnancy, High-Risk; D011320:Primary Health Care / Q000458:organization & administration*; D014481:United States