Coordination of care for children with special health care needs.
OBJECTIVE
Coordination of care is an essential function of pediatric primary care, needed most by children with special health care needs (CSHCN). Although complex, its necessity has become better recognized with the recent increase in attention in the United States to the comprehensive "medical home" model of care.


RESULTS
Coordination is highly dependent on effective communication within the health care system and between the health care system and the larger community. While coordination may best be undertaken at the level of the physician practice, a team approach involving nonphysician staff and families as primary participants may be the best option in many cases. More attention is being paid at the health policy level to the implementation of coordination of care, although solutions to reimbursement barriers have yet to be implemented. Considerable progress on methods to improve care coordination in the primary care practice setting has been made recently. Many of these efforts have used quality improvement techniques adapted from the business world. Emerging measures of the process of care coordination are also being developed, although few studies have been published to date showing a positive impact of care coordination.


CONCLUSIONS
The value of coordination of care as an essential part of medical care for children with special health care needs is becoming widely recognized. Methods to implement it within pediatric primary care practices are being developed, although more data demonstrating its value are needed to inform policy changes.
Stille
Christopher J
CJ
Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts, USA. stillec@ummhc.org
Antonelli
Richard C
RC
D002648:Child; D002662:Child Health Services / Q000458:organization & administration* / Q000592:standards; D002908:Chronic Disease / Q000628:therapy*; D019988:Children with Disabilities; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration* / Q000592:standards; D011320:Primary Health Care / Q000379:methods / Q000458:organization & administration* / Q000592:standards; D014481:United States