Boston Children’s maps new way of care

August 24, 2013 in Medical Technology

Richard Antonelli, MD, a primary care pediatrician and medical director of integrated care at Boston Children’s Hospital, has been thinking and working at making a difference in the field of care coordination for more than 20 years. He recalls that it was in 1983 when he started thinking about what he calls “the space between” – between a doctor’s visit and the next one with the same doctor, or a specialist to whom the primary physician has referred the patient. The space between is when the patient is on his or her own to remember (or not) the doctor’s instructions.

It’s a time when care coordination could smooth the path to recovery, to better health. With funding and testing work from the Verizon Foundation, Antonelli is prepared to launch several care coordination projects aimed at doing just that.

Q: How do you envision care coordination making a difference for patients?

A: The first 18 years of my career were spent in full-time community practice. Early on I realized that the way practices were configured was not optimal for delivering high quality care. Oftentimes there were workarounds. There was often not a standard way of communication. About 12 years or so ago, I actually started to define many aspects of what care coordination is. I did work for the Commonwealth Fund, which really laid out a framework of what care coordination is. The work is actually in this space of what my strategic charge is, which is to meaningfully engage patients and families in their own care – patient self-management.

Q: Did care coordination become important to you because of what you observed in your own practice?

A: For both personal reasons and certainly professional reasons, it became clear to me very early that a typical patient encounter, 10-20 years ago, went something like this: “OK, Mr. Smith, you, the patient, or your child, should see the following specialist. Here are their numbers, and I’ll see you back in a month.” In particular, I found that was never very satisfying. We asked families – families who had children with behavioral or mental health needs, and we found that 86 percent of the time the families were completely on their own to coordinate care amongst their primary care providers, their specialty care providers and their behavioral health providers.

[See also: Take ‘scary’ out of health IT innovation.]

Q. What is the thrust of care coordination?

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