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15935

Impact of Practice-Based Care Coordination On Health Services Utilization by High-Risk Children In Hartford, Connecticut

Friday, October 19, 2012
Room R06-R09 (Morial Convention Center)
Lisa Honigfeld, Ph.D.1, Laura Chandhok, MPH1, Richard C. Antonelli, M.D.2, Catherine Wiley, MD3, Mary Alice Lee, Ph.D.4, Paul Dworkin, MD5 and Grace Damio, MA6, (1)Child Health and Development Institute, Farmington, CT, (2)Pediatrics, Children's Hospital Boston, Boston, MA, (3)Primary Care Center, Connecticut Children's Medical Center, Hartford, CT, (4)Connecticut Voices for Children, New Haven, CT, (5)Connecticut Children's Medical Center, Hartford, CT, (6)Hispanic Health Council, Hartford, CT

Purpose

The goal of the Connecticut Children's Medical Center Health Outreach for Medical Equality (HOME) program was to promote the health of low-income children in Hartford by ensuring access to medical and community-based support services through primary care-based outreach and care coordination. The Connecticut Children's Medical Center primary care center served as the operational base for the HOME program. The Hispanic Health Council (HHC), a community-based research, service and advocacy organization, provided outreach and care coordination services. Over three years of operation, HHC care coordinators received referrals, conducted intakes, developed care plans, linked participants to needed services, and facilitated communication between families and providers for almost 2,000 children. An independent evaluator assessed the impact of the HOME program on participants' utilization of health services.

Methods

This report focuses on mental health and dental services utilization for children ages 0-17 who were enrolled in HOME prior to 2008 and were continuously enrolled in HUSKY (Medicaid) for all of 2008 (n=509). Mental health and dental services utilization data from 2008 for HOME participants were compared, using a two-tailed t-test and significance level of 0.05, to utilization rates for the general population of Hartford children insured by HUSKY during the same time period.

Results

Mental health services utilization was significantly higher among HOME participants than the general Hartford HUSKY population for all children over age 2. Percentages of children accessing mental health services among age 3-5: 8% HOME vs. 3% HUSKY (p= 0.02), age 6-8: 25% HOME vs. 9% HUSKY (p=0.00), age 9-11: 32% HOME vs. 13% HUSKY (p=0.00), age 12-14: 32% HOME vs. 15% HUSKY (p= 0.01), age 15-17: 30% HOME vs. 15% HUSKY (p=0.05). Utilization of preventive dental care was significantly higher among very young (age 0-2) HOME participants than among the general Hartford HUSKY population: 34% HOME vs. 25% HUSKY accessed services (p=0.02). Use of preventive dental care was also higher among adolescent HOME participants (age 15-17), approaching significance: 43% HOME vs. 26% HUSKY accessed services (p=0.06). Use of dental treatment services was significantly higher among very young and adolescent HOME participants compared with the general Hartford HUSKY population.

Conclusion

Connecting children with needed mental health and dental services presents a challenge to pediatric primary care providers.  The HOME program used community-based care coordinators to successfully connect high-risk children to needed services, including mental health and dental care.  Children served by HOME had higher utilization rates than the general Medicaid population, suggesting that primary care-based care coordination services can more effectively link families to services than routine referral by primary care providers. This finding may inform strategies toward connecting families with these and other medical and support services.