title: Evaluation of a statewide medical home program on children and young adults with asthma.
abstract: OBJECTIVE
  Asthma, the most common chronic condition among children, accounts for significant healthcare utilization and impact on quality of life. Care coordination in a medical home is considered standard practice, but has not been rigorously evaluated.
  
  
  METHODS
  We initiated this pilot study of children/young adults with asthma (n = 967), ages: birth to 24 years, receiving care from a subset of pediatric practices (n = 20) participating in the Pennsylvania Medical Home Initiative, Educating Practices in Community-Integrated Care (92 practices statewide). We hypothesized children and youth with asthma receiving care coordination in the context of a formal medical home program would experience favorable associations with healthcare utilization and quality of life measures.
  
  
  RESULTS
  A total of 9240 care coordination encounters for this cohort of children/youth occurred over 100 days. The average length of care coordination encounter was 20.7 minutes. The most common care coordination activity was referral management (21%) and the care coordinator in the practice most often contacted parent/family and specialists (75%). Children with more severe asthma had more hospitalizations and emergency department (ED) visits than children with less severe asthma. There was a significant decrease in school absences, ED visits and acute care visits for children/youth with asthma with increasing length of time in a medical home program (p < 0.05).
  
  
  CONCLUSIONS
  Care coordination for children/youth with asthma is feasible and may yield improvements in healthcare utilization, expenditures and quality of life. Larger-scale implementation of care coordination and medical home models for children/youth with asthma and other diagnoses are warranted.
authors.affiliation: a Nova Southeastern University College of Osteopathic Medicine , Fort Lauderdale , FL , USA .|b Department of Epidemiology and Biostatistics , School of Public Health, Drexel University , Philadelphia , PA , USA .
authors.forename: Robert
authors.initials: R
authors.lastname: Hamburger
authors.affiliation: b Department of Epidemiology and Biostatistics , School of Public Health, Drexel University , Philadelphia , PA , USA .
authors.forename: Zekarias
authors.initials: Z
authors.lastname: Berhane
authors.affiliation: c Make-A-Wish Foundation of Philadelphia and Susquehanna Valley , Blue Bell , PA , USA .
authors.forename: Molly
authors.initials: M
authors.lastname: Gatto
authors.affiliation: d Pennsylvania Chapter, American Academy of Pediatrics , Media , PA , USA .
authors.forename: Suzanne
authors.initials: S
authors.lastname: Yunghans
authors.affiliation: e Department of Community Health and Prevention , Maternal and Child Health Working Group, School of Public Health, Drexel University , Philadelphia , PA , USA .
authors.forename: Renee K
authors.initials: RK
authors.lastname: Davis
authors.affiliation: e Department of Community Health and Prevention , Maternal and Child Health Working Group, School of Public Health, Drexel University , Philadelphia , PA , USA .|f Department of Pediatrics , St. Christopher's Hospital for Children , Philadelphia , PA , USA , and.|g Department of Community Health and Prevention , School of Public Health, Drexel University , Philadelphia , PA , USA.
authors.forename: Renee M
authors.initials: RM
authors.lastname: Turchi
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007398:Interpersonal Relations; D008297:Male; D010348:Patient Care Team; D018802:Patient-Centered Care / Q000458:organization & administration*; D010865:Pilot Projects; D011788:Quality of Life; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Asthma; care coordination; children and youth with special healthcare needs; healthcare utilization; medical home; young adults