Medical Home Care Coordination in a Community Hospital Setting

Purpose

Children with complex medical conditions can benefit when their various services are well coordinated. Many academic medical centers have created complex care clinics that can serve as medical homes for these children and provide a centralized point of service, care planning and care coordination. These clinics can be challenged in their efforts to partner with community pediatric practices, especially those that serve children living in settings distant from the medical center. To address this challenge, this project will develop a detailed model and plan for implementation of a community-based complex care program emphasizing care coordination.