74 - Co-Design of a Novel Collaborative Model for Pediatric Primary Care

Publication Number: 2070.74

Mandy A. Allison, University of Colorado School of Medicine, Denver, CO, United States; Carol Franco-Rowe, University of Colorado School of Medicine, Johnstown, CO, United States; Lisa Ross. DeCamp, Children's Hospital Colorado | University of Colorado, Aurora, CO, United States; Jennifer Rosen, University of Colorado School of Medicine, Aurora, CO, United States; Venice N. Williams, University of Colorado School of Medicine, Aurora, CO, United States

Background: A barrier to successful implementation of the medical home in the U.S. is the centering of primary care in clinic settings that requires families to come to clinic for brief encounters with medical providers. Providing health and social care by 'meeting families where they are' may be more cost-effective and successful in addressing social drivers of health (SDOH) and reducing health disparities. Evidence-based home visiting (HV) programs literally meet families where they are by conducting visits in families' preferred settings. HVs figuratively meet families where they are by understanding families' goals and needs.

Objective: Use co-design to develop a model of collaborative primary care with HVs and pediatric primary care providers (PCPs).

Design/Methods: We convened a design team including HVs, parent leaders, PCPs, and Medicaid representatives. The design team: 1) identified gaps and challenges in pediatric care by creating a patient journey map, 2) identified components of a collaborative care model (CCM), 3) identified and prioritized measurable outcomes using a modified e-Delphi process, and 4) created a logic model for the CCM.

Results: Figure 1 shows the patient journey map with identified gaps and challenges. Figure 2 shows the CCM logic model. Gaps/challenges include relationship building between PCPs and patients and PCPs and HVs; lack of PCP appointment availability; language, cultural, and disability barriers; HVs and PCPs not informed about each other's screening, referrals, and follow-up; inconsistent messaging between PCPs and HV. Key components of the CCM include shared: electronic medical record access, education, resources, screening/assessment results, and understanding of roles and responsibilities between HVs and PCPs; asynchronous case conferencing; and reduction in clinic-centered visits. Key outcomes include cross-sector collaboration; identification of needs and utilization of services; parent/caregiver satisfaction, confidence, and well-being; child development and receipt of vaccines; and HV burnout.

Conclusion(s): The co-design process included parent, practitioner, and funder perspectives and resulted in creation of a CCM that is designed to address gaps/challenges in pediatric care and achieve priority outcomes. This CCM should be evaluated in a pragmatic trial to determine if it improves the medical home, addresses SDOH, and reduces health disparities.

Figure 1. Patient Journey Map


Figure 2. Collaborative Care Model (CCM) Logic Model
Figure 2. CPPC Logic Model_forPAS.pdfLogic model template adapted from Smith et al. Implementation Science (2020) 15:84 https://doi.org/10.1186/s13012-020-01041-8