Freeman Spogli Institute for International Studies Stanford University


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A Critical Analysis of Care Coordination Strategies for Children with Special Health Care Needs

Evidence Report

Paul H. Wise - Stanford University
LC Huffman
G Brat

Published by
Stanford-UCSF Evidence-based Practice Center, for the Agency for Healthcare Research and Quality, June 2007
Publication no. Publication No. 07-0054

Objectives: The goal of this technical review is to critically examine the issue of care coordination for children with special health care needs (CSHCN). Of particular interest is the knowledge base relating to those aspects of care coordination for CSHCN that are of greatest importance to current practice and policy challenges.

Review Methods: A structured search and review of the literature was conducted to address the following issues:

  1. Analytic approaches and definitions used for care coordination strategies for CSHCN.
  2. Evidence for best practices of care coordination for CSHCN.
  3. Evidence for the impact of managed care for CSHCN enrolled in Medicaid.

Results: Among the principal findings are:

  1. Despite considerable progress in defining care coordination and CSHCN, there remains considerable variation in current analytic approaches and definitions.
  2. Some progress has been made in developing care coordination strategies for CSHCN.
  3. There is a major need to evaluate the impact of these strategies on health outcomes and costs.
  4. Continued progress in care coordination for CSHCN may depend upon the replication and evaluation of promising strategies in different practice settings and under different reimbursement policies.
  5. The constructive assessment of enhanced care coordination programs in managed care systems would be facilitated by new, more focused metrics and performance measures.
  6. There is little evidence regarding the impact of managed care systems on CSHCN enrolled in Medicaid.

Recommendations: Among the principal recommendations are:

  1. Increase support for efforts to identify in a standard manner CSHCN in large administrative or clinical datasets.
  2. Expand efforts to evaluate care coordination interventions for CSHCN, particularly in managed care settings.
  3. Develop capacity and performance standards of direct relevance for CSHCN for managed care plans.
  4. Link development of care coordination programs for CSHCN to emerging practice and health system reforms.