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Disability Care Coordination Organizations: Improving Health and Function in People With Disabilities

Palsbo, Susan E. PhD; Mastal, Margaret F. PhD, RN; O'Donnell, Lolita T. PhD, RN, BS

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Disability care coordination organizations (DCCOs) combine attributes of the medical home model and community nursing. Teams of nurses and social workers collaborate with the client to arrange disability-competent medical and social services. This article synthesizes observational findings from site visits to approximately half of the DCCOs operating in 2004. DCCOs have 6 core clinical activities: comprehensive assessment; self-directed, person-centered planning; health visit support; centralized medical–social record; community resource engagement; and constant communication. We also identified 3 core business competencies: service coordination, patient education/behavioral modification, and continuous enhancement of disability competency. Each DCCO started as a new company rather than as a product line of an existing business, and each included the target population in the design stage. Most DCCOs contract with state Medicaid agencies under a prepaid capitation arrangement, and some also enroll Medicare beneficiaries. Capitated DCCOs retain cost savings and may be financially stronger than fee-for-service DCCOs. Although studies suggest that DCCOs improve coordination and clinical outcomes while reducing costs, the current evidence has not been peer reviewed.

Susan E. Palsbo, PhD, is a health services researcher specializing in innovative programs for persons with physical disabilities. Her current research seeks mechanisms to improve access to care for people with disabilities through telerehabilitation, health system organization, and quality measurement.

Margaret F. Mastal, PhD, MSN, RN, is an associate at Delmarva Foundation for Medical Care, a quality improvement organization. She conducts healthcare quality improvement studies and activities for programs serving persons with disabilities. Prior to that, she was a nurse and administrator in hospital and outpatient settings. She also served as the chief operating officer of Health Services for Children with Special Needs, Inc., a DCCO for the District of Columbia's pediatric SSI population.

Lolita T. O'Donnell, PhD, RN, BS, works primarily in quality improvement, nursing administration, and hospital accreditation. She teaches medical/surgical clinical rotation, healthcare leadership & management, professional issues and role integration, and case management. Her research interest includes ethics, case management, and developing transitional programs for foreign-educated nurses migrating to the United States.

Address correspondence to Susan E. Palsbo, PhD, Center for Study of Chronic Illness and Disability, George Mason University, 4400 University Dr MS 3C4, Fairfax, VA 22030 (spalsbo@gmu.edu).

Research for this article was supported by the Center for Health Care Strategies under its Medicaid Managed Care Program. A portion of this work was conducted while the first author was at National Rehabilitation Hospital/ MedStar Research Institute.

© 2006 Lippincott Williams & Wilkins, Inc.