Specific investments should be made for pediatric care practices by stakeholders, including infrastructure, education and privacy-secured technology, to meet the needs of “the whole child,” according to a recommendation issued by the AAP.
The statement also addresses the potential team members needed to successfully manage the care of children.
Julie P. Katkin
“Traditional health care models often fail to adequately address many issues affecting child health,” Julie P. Katkin, MD, FAAP, from the pediatric pulmonary medicine section in the department of pediatrics at Baylor College of Medicine, and colleagues wrote. “Coordinating feedback from caregivers, schools, dietitians and/or nutritionists, specialists, pharmacies, nursing agencies, vendors of durable medical equipment, and other home care agencies and counselors is regularly needed for many conditions [including asthma, diabetes, obesity or attention-deficit/hyperactivity disorder].”
The suggested framework — team-based care — is an integral part of the medical home, which was created in 1967 by the AAP and defined in 1992. Health care needs that arise between early infancy and adulthood are addressed through the medical home through the use of a team of health care professionals that may also include nurse practitioners, teachers, therapists, social workers or medical-legal partnerships, in any combination.
The researchers note that little research is available on team-based approaches in health care for children; however, single-center studies have demonstrated efficacy in health maintenance, prevention of disease and management of acute illness and chronic diseases. Large-scale studies are available to support this framework in the adult population, with benefits observed in higher quality of care, lower acute-care utilization and higher cost savings.
Because communication between health care providers is integral to the maintenance of team-based approaches, varying forms of technology may be implemented to facilitate the flow of information. These may include telehealth, patient portals, secure text messaging, personal health records, sharing through health information exchanges, integration and exchange of EHRs and OpenNotes. The type of technology that will best benefit practices and individual visits can be unique.
Although technology may ease communication and treatment of children in the medical home, many barriers exist that interfere with execution, including philosophical, technical, legislative and institutional obstacles. More development and support are needed to assist in making programs and technologies compatible while maintaining confidentiality.
The following investments have been suggested to support effective team-based pediatric care for all children and families:
- Payment models to support appropriate payment for implementation, ongoing infrastructure, collaboration and continuous improvement to sustain team-based care for children and families;
- Incorporation of the principles and practice of team-based care in medical school, residency training and continuing medical education, with development of team leadership skills for pediatricians, who will need education, implementation toolkits, technical assistance and infrastructure support to transform their practices;
- Implementation of technology-enabled communication to establish, support and strengthen communication across the care team. Electronic platforms are needed to share medical records and key information in an accessible format so that all team members, including children and families, can communicate in real time while respecting issues of confidentiality;
- Children and families should be confident that they are indeed at the center of each child’s care team. Shared decision-making skills are key to strengthening collaboration among team members, physicians and families;
- Information and incentives to partner with pediatricians and others dedicated to the health of children in a more comprehensive and collaborative team-based approach to care for communities. All stakeholders should examine how effectively they reach families and children who need services and should identify and collaborate to close gaps in resources. – by Katherine Bortz
Disclosure: Kressly has indicated that she is the medical director of Office Practicum, Pediatric Electronic Health Records; the other authors have indicated no potential conflicts of interest.