Enhancing Collaboration Between Primary and Subspeciality Care Providers for Children and Youth with Special Health Care Needs

Summary: The goals of this guide are to discuss the complementary roles of generalist and subspecialist physicians in providing coordinated and effective care for children and youth with special health care needs. We will emphasize the centrality of family-professional partnerships. We also will describe various models for collaboration among generalist and subspecialist physicians and families. Ultimately, the value of this guide will be to serve as a framework for discussion about how primary and subspecialty care physicians can work collaboratively to enhance the quality of care that children and youth with special health care needs and their families receive

Using Home Visits to Understand Medication Errors in Children

Summary: Current research methods are not well designed to detect medication errors that occur at home. We developed home visit methods to investigate home medication errors in children with chronic conditions. These methods include observation of parent administration of medication to the child by a trained nurse observer who takes detailed ethnographic notes; review of all prescription and over-the-counter medications for dispensing errors, pill counts, and medication reconciliation; and parent interviews to identify barriers to effective home use of medications, prior home medication errors that parents are aware of, and suggestions for systemic improvements. Details about each possible error detected are recorded using a structured data collection form (allergies, medication list, dispensing errors, administration errors). We conducted several pilot home visits and found that this approach has the potential to help understand home medication errors in order to develop interventions to improve the safety of medication self-management

Care Coordination for Children With Medical Complexity: Whose Care Is It, Anyway?

Children with medical complexity (CMC) have multiple chronic conditions and require an array of medical- and community-based providers. Dedicated care coordination is increasingly seen as key to addressing the fragmented care that CMC often encounter. Often conceptually misunderstood, care coordination is a team-driven activity that organizes and drives service integration. In this article, we examine models of care coordination and clarify related terms such as care integration and case management. The location of care coordination resources for CMC may range from direct practice provision to external organizations such as hospitals and accountable care organizations. We discuss the need for infrastructure building, design and implementation leadership, use of care coordination tools and training modules, and appropriate resource allocation under new payment models

Methodological Challenges in Describing Medication Dosing Errors in Children

Summary: Although children are prescribed medications in 30 percent to 50 percent of clinic visits, little is known about medication errors in ambulatory pediatrics. In the process of completing a study to determine the prevalence of outpatient dosing errors, we identified a number of barriers to understanding the epidemiology of medication errors in children. These barriers include prescribing medication that is not labeled for use in children, discrepancies in published dosing recommendations for many medications, unclear guidelines on use of adult dosing recommendations for children of different ages and weights, and the lack of readily available documented weights to determine appropriate weight-based doses for children. In our study of pediatric medication errors, we found a wide range of doses prescribed to children for every medication we studied. Before we can truly understand medication errors in children and begin developing systems-based approaches to eliminating these errors, we need better national standards of medication doses that are appropriate for children and an improved ability to determine errors through databases that include children\u27s weights as well as prescription information

Performance measures of the specialty referral process: a systematic review of the literature

<p>Abstract</p> <p>Background</p> <p>Performance of specialty referrals is coming under scrutiny, but a lack of identifiable measures impedes measurement efforts. The objective of this study was to systematically review the literature to identify published measures that assess specialty referrals.</p> <p>Methods</p> <p>We performed a systematic review of the literature for measures of specialty referral. Searches were made of MEDLINE and HealthSTAR databases, references of eligible papers, and citations provided by content experts. Measures were eligible if they were published from January 1973 to June 2009, reported on validity and/or reliability of the measure, and were applicable to Organization for Economic Cooperation and Development healthcare systems. We classified measures according to a conceptual framework, which underwent content validation with an expert panel.</p> <p>Results</p> <p>We identified 2,964 potentially eligible papers. After abstract and full-text review, we selected 214 papers containing 244 measures. Most measures were applied in adults (57%), assessed structural elements of the referral process (60%), and collected data via survey (62%). Measures were classified into non-mutually exclusive domains: need for specialty care (N = 14), referral initiation (N = 73), entry into specialty care (N = 53), coordination (N = 60), referral type (N = 3), clinical tasks (N = 19), resource use (N = 13), quality (N = 57), and outcomes (N = 9).</p> <p>Conclusions</p> <p>Published measures are available to assess the specialty referral process, although some domains are limited. Because many of these measures have been not been extensively validated in general populations, assess limited aspects of the referral process, and require new data collection, their applicability and preference in assessment of the specialty referral process is needed.</p

Communication, comanagement, and collaborative care for children and youth with special healthcare needs

Case report: Antonio is a 14-year-old patient well known to a pediatric practice. He has cerebral palsy with spastic quadriplegia, is nonverbal, has a stable seizure disorder, and has severe scoliosis. He has had some problems with poor nutrition and osteopenia in the past. He had a recent episode of viral pneumonia, which resulted in hospitalization in the pediatric intensive care unit for 2 weeks. It is becoming apparent that his scoliosis affects his respiratory function, and that he may require surgery. His mother is single, cares for him full time, and speaks only Spanish, although family support is excellent

Pneumonia

Pneumonia (infection of the lung parenchyma) in children is encountered commonly in daily practice, and otherwise healthy children typically do well with outpatient treatment. It is important, however, to recognize those children who are at risk for or who already are experiencing severe or complicated pneumonia and to monitor and treat them. Pneumonia usually can be diagnosed clinically, although radiographs may be useful to corroborate the clinical findings or identify complications. Antibiotic selection is important, and the treating clinician should consider prevalent organisms, the child\u27s age, and the presence of risk factors for atypical or resistant organisms. Occasionally, in more severe or complicated cases, hospitalization may be necessary to provide intravenous (IV) antibiotics, fluids, oxygen, and other supportive measures and to facilitate necessary invasive procedures to diagnose and treat complications. Fortunately, appropriate immunization and proper personal hygiene can go far in preventing pneumonia