Publication-Medical Home@AAP-Medical Homes@Work Announcements

"As demonstrated in earlier studies, CSHCN [children with special health
care needs] require and use more health care services, as well as incur
higher expenses. Our analysis shows that this also holds true for
IYCSHCN [infants and young children with special health care needs],"
state the authors of an article published in the April-June 2008 issue
of Infants and Young Children: An Interdisciplinary Journal of Special
Care Practices. Although multiple studies have evaluated heath care
expenditures for children with specific conditions, there is a paucity
of data addressing health care utilization and costs for young CSHCN.
This study describes the prevalence of special health care needs in
infants and young children (from birth to age 5) and delineates their
health care utilization, access, and expenditures, with an emphasis on
financial burden on families.

Data for the study were drawn from the 2001 and 2002 Medical Expenditure
Panel Surveys. The sample for the present study included 6,677 infants
and children, all of whom were identified as having or not having a
special health care need using the CSHCN screener. The analysis
calculated expenses for hospital inpatient and outpatient services,
physician services, dental services, services provided by health
professionals other than physicians, prescribed medication, diagnostic
tests, and certain types of medical equipment and supplies for all
individuals in the sample. Determinants of access to health care (unmet
needs, satisfaction) were also assessed and stratified by special needs
status. Payments were distinguished as either out-of-pocket costs to
families or from third-party payers, and the financial burden of
out-of-pocket expenses was measured.

The authors found that

* Approximately 11% of infants and young children from birth to age 5
had an identified special health care need.

* IYCSHCN were more likely than their peers without special health care
needs to have an identified usual source of care; to have unmet needs
for prescription medication, medical care, and urgent care; and to have
problems seeing a specialist.

* IYCSHCN used significantly more medical services than their
age-matched peers.

* Total yearly health care expenditures for IYCSHCN were significantly
higher than those of their peers without special health care needs
($2,923 vs. $770).

* An estimated 10.5% of families with an infant or young child with
special health care needs paid more than $500 over the course of a year
for health care expenses, whereas only 2.8% families of with an infant
or young child with no special health care needs did so.

"Despite the numerous programs available to IYCSHCN, . . . families
often experience high out-of-pocket expenses for services," state the
authors. They conclude that "as our understanding of the health care
needs for IYCSHCN improves, our ability to serve them will be enhanced."

Houtrow AJ, Kim SE, Newacheck P. 2008. Health care utilization, access,
and expenditures for infants and young children with special health care
needs. Infants and Young Children: An Interdisciplinary Journal of
Special Care Practices 21(2):149-159. Abstract available at
http://www.iycjournal.com/pt/re/iyc/abstract.00001163-200804000-00007.htm.

Readers: More information is available from the following MCH Library
resource:

- Knowledge Path: Children and Adolescents with Special Health Care Needs at
http://www.mchlibrary.info/KnowledgePaths/kp_CSHCN.html

Maternal Child and Health Bureau (MCHB) Announces Initial Release of Discretionary Grant Web Reports

The Discretionary Grant Information System (DGIS) Web reports display
financial, national performance measure, and abstract data collected
annually from more than 900 grants issued by the Health Resources and
Services Administration (HRSA), Maternal and Child Health Bureau (MCHB),
including data from grants to reduce disparities in infant mortality.
The public reports contain data collected by MCHB via a Web-based system
that allows grantees to report their data online as a part of the
grant-application and performance-reporting processes. Data contained in
the reports help MCHB assess the effectiveness of its programs and help
staff monitor the progress made under these grants. The DGIS complements
the existing Title V Information System (TVIS), which electronically
captures data from the annual Title V Block Grant applications and
reports submitted by all 59 U.S. states, territories, and jurisdictions.
The TVIS provides information on key measures and indicators of maternal
and child health (MCH) in the United States. The DGIS and Title V
reports are intended for use by public health professionals,
researchers, and the public in accessing concise information about
programs working to improve the quality of and access to health care for
MCH populations. Additional reports to be released in the future will
focus on other program and performance measure data. The DGIS reports
and the TVIS are available at http://www.mchb.hrsa.gov/data.

National Health Records Network to Expand

National health records network to expand

By Bob Brewin bbrewin@govexec.com March 27, 2008

The federal office in charge of creating a national network that intends to allow clinicians to exchange electronic health care information plans to expand the system this year to include electronic health records maintained by federal agencies as well as personal health records developed by "entrepreneurial organizations," a top official with the Health and Human Services Department said.

The Office of the National Coordinator for Health Information Technology plans this year to expand its Nationwide Health Information Network to exchange electronic health information with the departments of Defense and Veterans Affairs and the Indian Health Service, which operate electronic health record systems covering millions of Americans and integrated health care systems that span numerous communities, said Charles Friedman, chief operating officer for the national coordinator office. Friedman spoke March 26 at the Defense Health Care Information Technology Conference at Georgetown University in Washington.

The NHIN is a key component of a project that President Bush kicked off in 2004 to create a system that eventually will provide electronic health records for every American. Bush set 2014 as the deadline to have the majority of the public's electronic health records available to any doctor's office, hospital or clinic hooked up to the network. NHIN is conducting trials with nine organizations in broad geographic areas under contracts awarded last October.

Friedman provided few details on how the office would include in the NHIN information from personal health records developed by what he called "entrepreneurial organizations" such as Google. Last month, Google launched a pilot project with the Cleveland Clinic to provide patients the results of their doctor visits, prescriptions, tests and procedures through Google's secure Web authentication proxy service. A spokeswoman for the national coordinator's office said there is no agreement to include Google personal health records in the NHIN. In October, Microsoft launched a personal health record initiative called HealthVault.

To read the rest of this article, please visit http://www.govexec.com/dailyfed/0308/032708bb1.htm

National Committee for Quality Assurance (NCQA) Multi-Cultural Health Care Award

Deadline: May 30, 2008
NCQA, supported by The California Endowment, announces its third annual Recognizing Innovation in Multicultural Health Care award program to publicly recognize health plans that have implemented initiatives to ensure culturally and linguistically appropriate services and reduce health care disparities.

2008 Award winners will be honored at an awards event in San Francisco, Calif. on September 18, 2008. Awardees will also showcase their award winning initiatives at a poster session and reception before the event. All are invited to attend. Please contact CLASAwards@ncqa.org for more information.

Awards Overview
NCQA will highlight and recognize health plans for their exemplary efforts and demonstrated effectiveness in promoting cultural competence and addressing the health care needs of diverse members. Through these awards, NCQA hopes to advance efforts to improve multicultural health care and eliminate health care disparities.

The awards will also help:

Identify models for potential for replication in other settings and for shared learning
Provide a forum for dissemination and recognition of health plans’ efforts to address culturally and linguistically appropriate services and reduce disparities among their members and communities.
Inform NCQA as it develops voluntary accreditation standards to help organizations assess their efforts to address CLAS and disparities

Topic areas for applications, based on key concepts from the National Standards for Culturally and Linguistically Appropriate Services in Health Care developed by the Office of Minority Health, HHS, include:

Language Access
Cultural Competence
Reducing clinical disparities
Community driven programs/community partnerships
Culturally and linguistically appropriate patient education
Cross-cultural health initiatives
Quality and culture intersection
Culturally tailored disease management

For more information, please contact CLASAwards@ncqa.org

Medical Home Series: Medical Home and the Network of Supports it Offers Children and Youth with Special Healthcare Needs: The Transition Process Continues – Part 8

By Sarah Macdonald, MD; Suzanne McLaughlin, MS, MD; Eric Levey, MD; and May 1, 2008 - 4:18:44 PM

As Anjali sat behind the cash register, she thought about words. How did the people who wrote greeting cards come up with so many new ways to say the same old thing over and over? Like the card with the big yellow duck on the outside:

Now you are three! You are so lucky!

Hope your birthday is really Ducky!

Or the one with the ballerina curtseying:

Sorry to be tutu late for your birthday

She quickly texted her best friend Paige:

At work u

Have new fav card

Paige: What

Anjali: Tutu late for bday

Paige: hahaha

Anjali had been working at the card store for the past four months. She liked working. She loved the paycheck although she was shocked when she saw how much was taken out for taxes. She liked the orderliness of the card racks. She liked reading the cards. And she loved being at the mall! Paige also worked on the upper level, just a few stores down. They would meet during their break and sit on a bench overlooking the lower level. They would watch the shoppers, the mall walkers, and, especially, the other teens.

At first, Anjali didn’t really want a job. She was nervous about running into classmates, especially kids she wasn’t friendly with. She was worried about getting hired. She didn’t know how she would get to and from the mall. She thought a shop owner would see her shuffling gait, her leg braces, her thick glasses and assume she wasn’t competent. But when Paige got a job at the mall’s pretzel stand, Anjali decided to apply.

In order to get her job, Anjali had to go see her pediatrician, Dr. Butler, to get her working papers signed. Dr. Butler did a physical exam, asked her some questions about the work she would be doing, and signed the forms. Then he suggested this was a good time for Anjali to make an appointment with his nurse and care coordinator, Molly, to talk about getting a state ID card, figuring out some transportation options, and reviewing her insurance. Anjali wasn’t surprised by this suggestion. She knew it was part of what Dr. Butler called her “transition,” her preparation for living as an independent adult, one with special healthcare needs.

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Healthy Ready to Work National Resource Center (HRTW) Topical Call #6, Ways Title V Can Support Pediatric and Adult Medical Homes, May 7, 2008

TIME: 3:00 PM – 4:00 PM Eastern

1:00 – 2:00 pm Mountain
12:00 – 1:00 pm Pacific
11:00 – 12:00 am Alaska
10:00 – 11:00 am Hawaii

CALL:  1-800-567-5900

ACCESS CODE:  870036#

Line with be open 15 minutes prior to the call.  Please dial-in before the scheduled time. Presenters will start promptly at 3:00 EDT.

TOPIC: One of the challenges facing Title V CYSHCN programs is to simultaneously improve the pediatric health care system and prepare youth for successful transition to an adult-focused medical home. Another challenge is to support physicians who will provide adult medical homes for the transitioning YSHCN. During the call, the speakers will:

Discuss national efforts to support the medical home across the lifespan, including collaborative ventures of the American Academy of Pediatrics, American Academy of Family Physicians, American College of Physicians, American Osteopathic Association and others
Describe services provided by a State Title V CYSHCN program to support physicians as they put the medical home model into practice
Describe steps that have been taken—and the challenges faced—in educating pediatric and other primary care physicians to prepare YSCHN for transition and in recruiting adult-focused physicians to become the medical homes for young adults with special health care needs

FEATURED SPEAKERS:

Richard C. Antonelli, MD, FAAP, MS, Director, Department of General Pediatrics, Connecticut Children’s Medical Center; Co-Head, Academic Division of General Pediatrics, University of Connecticut School of Medicine; and Medical Home and Transition Advisor, HRTW National Resource Center

Patience H. White, MD, FAAP, MA, Chief Public Health Officer, Arthritis Foundation, Professor of Medicine and Pediatrics at George Washington School of Medicine and Health Sciences, and Medical Home and Transition Advisor, HRTW National Resource Center

Charles N. Onufer, MD, FAAP, Director, Division of Specialized Care for Children (Illinois Title V CYSHCN program), University of Illinois – Chicago

Gerri Clark, RN, MSN, Associate Director for Program Services, Division of Specialized Care for Children, University of Illinois – Chicago

Before the call, FIND AGENDA, RESOURCE MATERIALS, and ON-LINE EVALUATION AT: http://www.hrtw.org/hrtwu/index.html An audio recording and a written transcript of the call will be posted following the call

CityMatCH Urban Maternal Child Health Leadership Conference, September 20-23, 2008, Albuquerque, NM

The CityMatCH is a freestanding national membership organization of city and county health departments’ maternal and child health programs and leaders representing urban communities in the US. The theme of the 2008 CityMatCH conference is “A Life Course Perspective: Pathways for Improving Practice in Urban Maternal and Child Health (MCH). For more information, please visit CityMatCH Urban Maternal and Child Health Leadership Conference.

Opening Doors: A State of the Science Conference, November 10-11, 2008, Bethesda, MD

OPENING DOORS: A State of the Science Conference on accessing services for children and youth with disabilities and special health care needs from traditionally underserved communities. Opening Doors is a five-year Rehabilitation Research and Training Center funded by NIDRR/U.S. DOE. Partners: ICI, Children’s Hospital Boston, UMass Boston, Mass. Consortium for Children with Special Health Care Needs, PACER, and Opening Doors community partners. The conference is sponsored by NIDRR, the HSC Foundation, MCHB, and the American Academy of Pediatrics. For more information, contact Berenise Reyes-Albino at berenise.albino@umb.edu or 617-287-4314; http://www.openingdoorsforyouth.org/sos/

A call for papers will be coming in Spring 2008.

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