Helping the Sickest Children Navigate the Health Care System

Dealing with the health care system can be frustrating no matter who you are, or how healthy you tend to be. Think, though, of the children who have long-term, serious conditions.

A child with cerebral palsy, for example, may need special equipment just to survive. She may need to visit several different doctors – a primary care doctor, a neurologist, an orthopedist, a gastroenterologist. She may have infections that lead to regular emergency department visits.

Day-to-day life may be a struggle for her and her family. Care probably won’t be as good as it can be, simply because there is too much for a family to coordinate on its own. The reality is that these children and their families spend a lot of time trying to figure out the health care system – time better spent trying to be well.

Enter Care Navigation. It’s a program to help some of the very sickest children, and the people who love them, navigate the health care system. Care Navigation is part of Partners For Kids, an organization formed by Nationwide Children’s Hospital and more than 1,000 doctors.

Some children in Partners For Kids have very complex, long-term conditions. Aligning their care is like putting together a jigsaw puzzle. So the Care Navigation program provides people who can help make the puzzle pieces fit.

Those people are care coordinators – nurses, social workers and quality outreach professionals – who have experience working inside the system. The coordinators can:

  • Visit families at home to learn about their individual issues
  • Schedule several doctors’ appointments on a single day, reducing the number of trips a family must make to the hospital
  • Actually attend those appointments with the families, to make sure their needs are addressed
  • Get patients the screenings and treatment they need
  • Help connect families with useful resources, like financial assistance for special medical equipment
  • Teach patients self-management so that as they grow, they can move to adult health care

We know the program is working. Children with complex conditions spend less time in the hospital after they enroll in Care Navigation, and they don’t go to the emergency department as often.

As an organization, PFK is responsible for providing medical care to 320,000 children in central and southeastern Ohio. These children qualify for Medicaid, so they already have some financial challenges. Most are healthy, thankfully. They need normal pediatrician visits and little in the way of care coordination.

Care Navigation began in 2013, and it’s been growing ever since. In early 2014, about 280 children were enrolled in the program. By March of this year, there were more than 900. We are in the process of hiring even more care coordinators so we can help even more children.

If you want to learn more about Partners For Kids and how it’s helping the children in our community, click here.

Kelly J. Kelleher, MD
Dr. Kelleher is a pediatrician whose research interests focus on accessibility, effectiveness and quality of health care services for children and their families, especially those affected by mental disorders, substance abuse or violence. He has a longstanding interest in formal outcomes research for mental health and substance abuse services. Dr. Kelleher is director of the Center for Innovation in Pediatric Practice and vice president of Health Services Research at The Research Institute at Nationwide Children's Hospital. Dr. Kelleher is also Professor in the Department of Pediatrics of The Ohio State University College of Medicine.

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