title: Meeting the needs of children with medical complexity using a telehealth advanced practice registered nurse care coordination model.
abstract: Effective care coordination is a key quality and safety strategy for populations with chronic conditions, including children with medical complexity (CMC). However, gaps remain in parent report of the need for care coordination help and receipt of care coordination help. New models must close this gap while maintaining family-centered focus. A three-armed randomized controlled trial conducted in an established medical home utilized an advanced practice registered nurse intervention based on Presler's model of clinic-based care coordination. The model supported families of CMC across settings using telephone only or telephone and video telehealth care coordination. Effectiveness was evaluated from many perspectives and this paper reports on a subset of outcomes that includes family-centered care (FCC), need for care coordination help and adequacy of care coordination help received. FCC at baseline and end of study showed no significant difference between groups. Median FCC scores of 18.0-20.0 across all groups indicated high FCC within the medical home. No significant differences were found in the need for care coordination help within or between groups and over time. No significant difference was found in the adequacy of help received between groups at baseline. However, this indicator increased significantly over time for both intervention groups. These findings suggest that in an established medical home with high levels of FCC, families of CMC have unmet needs for care coordination help that are addressed by the APRN telehealth care coordination model.
authors.affiliation: University of Minnesota, 420 Delaware Street SE, MMC 609, Minneapolis, MN, 55455, USA, rhondagcady@gillettechildrens.com.
authors.forename: Rhonda G
authors.initials: RG
authors.lastname: Cady
authors.forename: Mary
authors.initials: M
authors.lastname: Erickson
authors.forename: Scott
authors.initials: S
authors.lastname: Lunos
authors.forename: Stanley M
authors.initials: SM
authors.lastname: Finkelstein
authors.forename: Wendy
authors.initials: W
authors.lastname: Looman
authors.forename: Margaret
authors.initials: M
authors.lastname: Celebreeze
authors.forename: Ann
authors.initials: A
authors.lastname: Garwick
mesh_terms: D057179:Advanced Practice Nursing; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000628:therapy*; D003153:Community Health Services / Q000458:organization & administration / Q000592:standards*; D003266:Continuity of Patient Care; D003299:Cooperative Behavior; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009740:Nursing Staff; D010043:Outcome and Process Assessment, Health Care; D018802:Patient-Centered Care / Q000458:organization & administration*; D010372:Pediatrics; D011787:Quality of Health Care; D017216:Telemedicine