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  • ANTONELLI, Richard, 2018. Implementing Effective Integrated Care Management for Children and Youth with Special Health Care Needs. In: ISSOP2018 - Early Childhood Intervention: Science, Systems and Policies - Promoting Healthy Development of Vulnerable Children [online]. Bonn, Germany: DGSPJ. 28 September 2018. p. 1–120. [Accessed 4 November 2018]. Available from: https://www.issop.org/cmdownloads/antonelli-issop-2018/

    The World Health Organization defines integrated health services as “those that are managed and delivered so that people receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation and palliative care services, coordinated across the different levels and sites of care within and beyond the health sector and according to their needs throughout the life course”

    To implement a rigorous, measurable approach to care integration, we will discuss the development and implementation of a framework of care integration, with a person-/ family-reported experience measure at its core. It is applicable to all aspects of service delivery including medical, behavioral, social, educational, and family support. A critical component of this effort is the implementation of an interprofessional educational offering supported by a multidisciplinary Care Coordination Curriculum. Patients and families engage as both learners and as co-faculty.

    In this session, we will discuss strategies and tactics to measure care fragmentation and promote integrated care in both adequately resourced and resource challenged settings. We will demonstrate outcomes of care integration projects for children, youth, and young adults with complex and special health care needs which align with the domains of patient/ family experience, quality, resource utilization, and provider experience.

    Authors, Institutions:  Richard C. Antonelli, MD, MS, FAAP,  Medical Director of Integrated Care, Boston Children’s Hospital ; Assistant Professor of Pediatrics, Harvard Medical School