Complexity of health care needs and interactions in multidisciplinary medical teams

By using an information processing and social identity approach, this study examines the relationships between the complexity of the health care needs of a patient and (1) the interactions among physicians during team meetings and (2) how the meeting participants evaluate the discussion. Three dimensions of the complexity of the health care needs are related to the interactive behaviour of medical specialists during meetings of multidisciplinary medical teams. Three medical teams from a Dutch university hospital, each discussing a total of 40 patients, were observed. The results show that component complexity was positively related to the amount of information team members exchanged, to positive reactions, and to the positive evaluation of the discussion. Two other dimensions (interrelatedness of needs and ambiguity) have to be considered in concert: interrelatedness was positively related to negative reactions but only if ambiguity was low; and, further, ambiguity was positively related to evaluative behaviour and to positive reactions, and negatively to the evaluation of the discussion, but only if interrelatedness was low.     

A Triage Tool to Assess Unmet Health Needs for Children Entering Foster Care

Children in foster care have high levels of health care needs, many of which are unmet at foster care entry. Health care coordination (HCC) is essential to ensure unmet needs are addressed rapidly. Data is lacking about how best to triage children at foster care entry so limited HCC resources can be allocated most effectively. Therefore, we aimed to: (1) utilize a Triage Tool (TT) at foster care entry to stratify children based on unmet health care needs and (2) determine if the TT is an accurate predictor of health care utilization as indicated by cost during a child’s first few weeks in care. A TT was developed and utilized during the initial foster care health exam (IFCHE) to stratify children based on unmet needs. Medicaid records were reviewed to determine health care utilization and cost during the first 60 days post-IFCHE. Most children (61.6%) had the lowest level of unmet needs (Level 3), 29.5% had a moderate level of unmet needs (Level 2), and 9.9% had the highest level of unmet needs (Level 1). Medicaid claims review revealed that triage level did not correlate to health care utilization or costs during the first 60 days post-IFCHE. Youth placed in a group home incurred significantly higher costs than those placed in foster homes. These results suggest that the TT is useful clinically but does not predict health care utilization and costs during the first weeks in care. Group home placement incurs more cost than foster home placement, independent of triage level assigned.