A tertiary care-primary care partnership model for medically complex and fragile children and youth with special health care needs.

OBJECTIVE: To evaluate the impact of a tertiary care center special needs program that partners with families and primary care physicians to ensure seamless inpatient and outpatient care and assist in providing medical homes.

DESIGN: Up to 3 years of preenrollment and postenrollment data were compared for patients in the special needs program from July 1, 2002, through June 30, 2005.

SETTING: A tertiary care center pediatric hospital and medical school serving urban and rural patients.

PARTICIPANTS: A total of 227 of 230 medically complex and fragile children and youth with special needs who had a wide range of chronic disorders and were enrolled in the special needs program.

INTERVENTIONS: Care coordination provided by a special needs program pediatric nurse case manager with or without a special needs program physician.

MAIN OUTCOME MEASURES: Preenrollment and postenrollment tertiary care center resource utilization, charges, and payments.

RESULTS: A statistically significant decrease was found in the number of hospitalizations, number of hospital days, and tertiary care center charges and payments, and an increase was found in the use of outpatient services. Aggregate data revealed a decrease in hospital days from 7926 to 3831, an increase in clinic visits from 3150 to 5420, and a decrease in tertiary care center payments of $10.7 million. The special needs program budget for fiscal year 2005 had a deficit of $400,000.

CONCLUSION: This tertiary care-primary care partnership model improved health care and reduced costs with relatively modest institutional support.