Care Coordination

Connecticut Children’s Office for Community Child Health Strengthens Clinical Care Delivery

By: Paul H. Dworkin, MD

Connecticut Children’s Office for Community Child Health (the Office) is a national leader in developing and supporting innovations to strengthen families and community programs to promote healthy development and help children reach their full potential. However, our work is also having a measurable impact inside our hospital walls through innovations that strengthen clinical care delivery and connect medical center services to community services.

Here’s a look at a few ways in which the work of the Office helps to enhance the clinical services children and families receive:

Strengthening System of Support for Children Visiting Emergency Department with Behavioral Health Needs

Emergency departments in Connecticut and around the country have long been overwhelmed by families seeking mental health treatment for their children in times of crisis. After the tragedy at Sandy Hook Elementary School in Newtown, the demand for such care at emergency departments grew. With many families returning again and again, Connecticut Children’s Center for Care Coordination realized more could be done to get families the help they needed outside a hospital setting. Staff members identified a gap in connecting families to community-based services upon discharge from the ED, so they developed and launched a pilot program in our emergency department to match families with a clinical care coordinator upon discharge. The care coordinator works with the family to develop a crisis plan, works with their schools and primary care physicians to ensure all stakeholders are familiar with the plan, and helps them connect with community-based programs for ongoing support.

A pilot study of the program is ongoing. An initial evaluation of data from three months showed 40 percent of patients with an urgent mental health issue met the criteria to be connected to our enhanced care coordination services upon discharge. More than half of those patients enrolled in the program. Care coordinators were able to connect with community providers, such as primary care physicians, schools, and mental health providers, about their cases 339 times which indicates that providing care coordination to mental health patients upon their discharge from the emergency department is feasible. Future evaluations will look into the cost effectiveness of the program as well as its effectiveness at keeping children from returning to the emergency department for help.

Using Electronic Health Record to Connect Health Providers, Community Services and Families

More Office programs now have access to Connecticut Children’s electronic health record and can use clinical information to seamlessly connect children and their families to community services. For example, Connecticut Children’s Center for Care Coordination (the Center) is able to review clinical notes for pertinent medical and social information, review provider recommendations, and gain a preliminary understanding of the family’s various needs. In addition, physicians and other providers will soon be able to make electronic referrals to the Center directly through the system. Also, the Center will soon be able to input notes into the system and share care plans directly with physicians. This access is critical to providing care coordination that is efficient and effective, while reducing redundancy and duplicative services. The ability of programs, such as the Center, to access the electronic health record encourages increased collaboration among providers.

Enhancing Capacity of Pediatric Primary Care

With growing demand for care leading to longer waits for appointments with subspecialists, Connecticut Children’s Co-Management Program sought to develop enhanced referral guidelines to identify when referrals to subspecialists are necessary. It launched CLASP, Connecticut Children’s Leaders in Advanced Solutions in Pediatrics, which suggests referral criteria and provides education and easy to use collaborative care tools to primary care providers to expand their scope of practice to manage common, lower-acuity conditions, such as headaches, obesity and concussions, which would otherwise be seen by a specialist. The program also developed an app to make it easier for primary care providers to access the referral guidelines at the point of care when considering a referral. As result of CLASP’s success, many children have their health concerns addressed more quickly in primary care and patients who need subspecialty care have shorter wait times for their appointments.

To date, more than 1,000 pediatricians have used our CLASP tools. An early study indicates participating primary care physicians were able to identify and confirm a concussion diagnosis for all of their patients who presented with such symptoms. Also, at their initial primary care visit, treatment plans were developed for 97 percent of those patients. In addition, 93 percent of those patients received educational materials on concussions. Additional data indicates that patients in the Co-Management group received more primary care visits, and more follow-up visits, in a primary care setting compared to patients who were not co-managed. More recent data indicates nearly 90 percent of children with headaches whose primary care providers followed our CLASP recommendations and used our tools got better without having to see a specialist.

Moving Forward

In bridging the hospital to the community, the Office is strengthening families, building stronger communities and enhancing clinical care – all to fulfill Connecticut Children’s goal of making Connecticut’s children the healthiest the country.

Paul H. Dworkin, MD, is the executive vice president for community child health at Connecticut Children’s, the director of Connecticut Children’s Office for Community Child Health and the founding director of the Help Me Grow® National Center. Dr. Dworkin is also a professor of pediatrics at the UConn School of Medicine.  Learn more »

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