Office of Epidemiology and Research, Division of Research

Advancing Applied MCH Research

Co-Management of Complex Neonates: Supporting the Medical Home

Funded Projects Search


Project Number: R40MC23626
Grantee: University of Arkansas for Medical Sciences
Department/Center: Pediatrics
Project Date: 2/1/2012
Principal Investigator: Dennis Kuo

Final Report



  • Perinatal/Infancy (0-12 months)


This project supports the development and evaluation of an innovative system of care integration for children with special health care needs (CSHCN), focusing on children with medical complexity (CMC). Such children are a subset of CSHCN with an exceptionally high number of family-identified service needs, clinical diagnoses associated with high morbidity and mortality, functional limitations, and high health resource utilization. The Medical Home Clinic for Special Needs Children (MHCL) at Arkansas Children's Hospital (ACH) provides care coordination, medical expertise, and family support for CMC, with a demonstrated reduction in total Medicaid costs. We propose the development of an innovative co-management protocol for complex neonates, or CMC <1 year of age transitioning from the neonatal intensive care unit (NICU) to the community setting. The co-management protocol will extend MHCL services to three community-based, primary care medical homes in outlying areas of Arkansas. Co-management will be developed jointly with three community-based practices and family partners and be implemented through improvement science. The project contains two Specific Aims: (1) Process - tailor and implement a tertiary/primary co-management care protocol for complex neonates; (2) Outcomes - demonstrate overall reduction of health service use by complex neonates. The process evaluation will utilize a staggered intervention design and be evaluated using statistical process control charts. The outcomes evaluation will utilize a quasi-experimental, pretestposttest design with chart review. We hypothesize that learning collaboratives and improvement science will improve care processes in the medical home, and that complex neonates will have improved service access and fewer hospitalizations and emergency room visits. The knowledge gained from this proposal can be used to develop and promote tertiary/primary co-management for all CMC. Co-management for complex neonates addresses all four Maternal and Child Health Bureau strategic issues by (1) improving the system of care for CSHCN, (2) reducing barriers to health care for a specific MCH population, (3) assuring quality of care, and (4) promoting healthy development of this vulnerable population. This project has significant public health implications since CMC are disproportionate users of health care resources. Optimal management of CMC can reduce immediate and future health care costs; improve neurodevelopmental outcomes, leading to higher education gains and future employment abilities; and address pediatric subspecialty distribution, by raising the level of care provided in the community setting. Improving care access in communities can address health disparities endemic to the rural and impoverished settings of many children in Arkansas and nationally.


Listed is descending order by year published.

Kuo DZ, Lyle RE, Casey PH, Stille CJ. Care System Redesign for Preterm Children After Discharge From the NICU. Pediatrics. 2017 Apr;139(4)

Stille CJ, Honigfeld L, Heitlinger LA, Kuo DZ, Werner EJ. The Pediatric Primary Care-Specialist Interface: A Call For Action. J Pediatr. 2017 Aug;187:303-308.

Kuo D.Z., Carroll J.L. (2016) The Model of Care for the Ventilator-Dependent Child. In: Sterni L., Carroll J. (eds) Caring for the Ventilator Dependent Child. Respiratory Medicine. Humana Press, New York, NY


Access to Health Care, Clinical Practice, Coordination of Services, Health Care Utilization, Medical Home, Primary Care, Rural, Special Health Care Needs, Infant Illness & Hospitalization, Health Care Quality

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