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P3RC: Parent-Provider Partnerships for Referral Communication in the Medical Home
Project Number: R40 MC 23632
Grantee: University of Colorado Denver
Project Date: 2/1/2012
Christopher Stille, MD, MPH
Section Head and Professor
13123 East 16th Avenue, B032, Mail Stop F428, PO Box 6508
Aurora, CO 80045-0508
- Perinatal/Infancy (0-12 months)
- Toddlerhood (13-35 months)
- Middle Childhood (6-11 years)
- Adolescence (12-18 years)
Over half of children and youth with special health care needs (CYSHCN) require specialty care annually. When referrals are made from the primary care medical home to specialty care, communication between primary care providers (PCPs) and specialists is frequently incomplete or nonexistent. As good communication is essential for coordinated care and family-centered care (FCC), its failure can contribute to unmet family needs, duplication or omission of needed services, and the potential for medical errors. With poor provider communication, patients and families become the only method of information transfer. While most parents favor taking an active role in information exchange with their child's physicians, neither feel comfortable with parents being the only means of communication. No published strategies exist for promoting physician-parent collaboration in the referral/consultation process. Further, over 1/3 of families of CYSHCN report problems with FCC, and Latino families are at particularly high risk. A critical need for CYSHCN is to improve communication between parents, primary care and specialty physicians. We propose to implement a two-pronged intervention to enhance provider communication and to support parents' participation in specialty referral. The overall goal of this three-year study is to test a brief, practice-based intervention using a communication tool and brief parent coaching to increase the capability of parents of CYSHCN to exchange and use medical information in partnership with their child's primary care and specialty physicians. Enhanced communication and parent partnership will, in turn, improve patient outcomes. It addresses 3 MCHB research issues: II, services and systems of care to eliminate health disparities and barriers to health care access; III, services and systems to assure quality of care for MCH populations; and IV, promoting the healthy development of MCH populations, by studying an intervention to promote family-professional partnerships in a diverse community. Two specific aims are proposed. Aim 1 (Year 1) will adapt a paper-based primary carebased intervention incorporating a "referral care plan" and brief parent education to the electronic medical record environment, to be used by providers and parents to communicate and plan care together. We will translate the referral care plan into Spanish and work with a Latina parent expert to ensure these are culturally appropriate. Aim 2 will test this intervention in at least 400 patient/parent dyads referred from ~50 pediatric primary care providers in 9 practices in two regions with a socioeconomically and ethnically diverse mix of patients and families. Using the principles of team-based care in the Medical Home, the brief education will be delivered by office-based care coordinators or patient navigators to the extent possible. We will evaluate referrals from these practices to 4 subspecialties at Children's Hospital Colorado and Oklahoma Children's Hospital to assess the intervention's usability, transportability, and impact on outcomes including parent self-efficacy, appropriate utilization of services, and missed work and school days. We will use a "stepped-wedge" intervention design, where the intervention will be phased in practice by practice over one year, with the experiences of patients and providers who do not initially receive the intervention serving as a comparison group. Results will inform further effectiveness studies of family-physician partnerships for CSHCN in a wider variety of settings, as well as studies of family-provider partnerships on other topics.
Listed is descending order by year published.
Stille CJ, Lockhart SA, Maertens JA, Madden CA, et al. Adapting practice-based intervention research to electronic environments: opportunities and complexities at two institutions. EGEMS (Wash DC). 2015;3(1):1111.
Chronic Illness, Clinical Practice, Coordination of Services, Health Care Utilization, Medical Home, Primary Care, Special Health Care Needs