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Improving outcomes through care coordination

Measuring care coordination of nurse practitioners

Ruggiero, Kristine PhD, MSN, RN, CPNP (Pediatric Nurse Practitioner, Nurse Scientist and Assistant Professor of Nursing)1,2; Pratt, Patricia BSN, MA, CPHQ, CPN (Vice President and Associate Chief Nurse Pediatric Medical Services)3; Antonelli, Richard MD, MS (Medical Director, Integrated Care, Assistant Professor of Pediatrics, Harvard Medical School)4

Journal of the American Association of Nurse Practitioners: August 2019 - Volume 31 - Issue 8 - p 476–481
doi: 10.1097/JXX.0000000000000276
Quality Improvement Research

Background: Gaps in care coordination (CC) between inpatient and outpatient settings for children with medical complexity (CMC) can result in treatment delays, gaps in communication, missed appointments, medication discrepancies, and ultimately impacts the provision of quality care.

Local problem: As care for pediatric patients with medical complexity moves into community settings, various ambulatory settings, including infusion settings, are caring for patients who would otherwise often require inpatient hospitalization to receive their care. To better accommodate this growing demand, nurse practitioners (NPs) have been used to support these nurse-led infusion programs. The purpose of this quality improvement (QI) project was to quantify and describe the outcomes of CC by NPs in this ambulatory setting.

Methods: A quantitative design was used.

Interventions: We captured nonreimbursable CC activities provided by NPs and associated outcome(s) among pediatric patients seen in two ambulatory infusion clinics, at Boston Children's Hospital between January and April 2017, and generated summary statistics for this QI project.

Results: There were 259 nonreimbursable CC encounters. Most of the CC activities prevented delays in treatment (38%), adverse reaction to medicine because of medication discrepancies (8%), need for additional subspecialist visits (10%), missed infusion appointments (5%), and emergency department visits (2%).

Conclusion: Nonreimbursable CC provided by NPs in a tertiary hospital-based ambulatory program improved outcomes of care for CMC and helped facilitate health care use. This project quantified and described the outcomes of CC provided by NPs, and the value of CC on CMC.

1Boston Children's Hospital, Center of Ambulatory Therapy and Clinical Research, Boston, Massachusetts,

2MGH Institute of Health Professions, School of Nursing, Boston, Massachusetts,

3Nursing Patient Services, Pediatric Medical Services, Boston Children's Hospital, Boston, Massachusetts,

4Boston Children's Hospital, Integrated Care Program/Harvard Medical School Boston, Massachusetts

Correspondence: Kristine Ruggiero, PhD, MSN, RN, CPNP, Boston Children's Hospital, Center of Ambulatory Therapies and Clinical Research, 300 Longwood Avenue, Boston, MA 02115. Tel: (978) 886-3642; Fax: (781) 216-1503; E-mail:

Competing interests: The authors report no conflicts of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Authors' contributions: P. Pratt and K. Ruggiero developed this QI project. R. Antonelli and K. Ruggiero modified the instrument and performed all the descriptive analyses; K. Ruggiero wrote the initial draft of the manuscript; all authors revised the manuscript for final submission.

Received January 14, 2019

Received in revised form May 30, 2019

Accepted June 06, 2019

© 2019 American Association of Nurse Practitioners
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