Care Coordination for Pediatric Patients at Federally Qualified Health Centers in Arizona
Childhood chronic diseases have increased dramatically in the past few decades in the United States. Care coordination in patient- or family-centered medical home (PCMH/FCMH) models is one evidence-based strategy to help better manage childhood chronic diseases. Federally qualified health centers (FQHCs) primarily serve uninsured, Medicaid, low-income and/or minority populations, and many incorporate PCMH/FCMH care coordination models. To date, few studies have investigated care coordination understanding by FQHC personnel. Limited studies have examined the levels of care coordination activities in urban versus rural FQHC locations. The effect of FQHC location on care coordination for childhood health conditions has not been well documented in the literature. In an effort to address gaps in information, this study employed a mixed-methods approach to investigate how FQHC personnel understood and practiced care coordination for pediatric patients and identified the relationship between FQHC location and levels of care coordination activities, using an ecological model. The findings suggest that neither the personnel’s occupational title nor the FQHC location is a contributory factor in terms of understanding of care coordination, but FQHC location matters in terms of levels of care coordination activities. Overall, both urban and rural FQHCs tended to provide greater levels of care coordination activities; however, the urban FQHC was more likely to provide greater levels of care coordination activities than the rural FQHC. Limited resources, including medical and non-medical resources, are barriers to the rural FQHC’s providing greater levels of care coordination activities in general, compared to its urban counterpart. In order to improve outcomes associated with care coordination, having a solid working definition of care coordination, taking care of patients’ medical and non-medical needs, building all levels of partnerships, reimbursing care coordination activities and certifying care coordinators should be explored.
care coordination, federally qualified health centers, patient-centered medical home, pediatric patients, referral, urban versus rural settings
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