CoIIN State Team Work: Indiana

Using a primary-tertiary care coordination collaborative to create comprehensive, functional, fluid shared plans of care (SPoCs) for 300 identified families

Lead Organization: Indiana State Department of Health, Children’s Special Health Care Services (CSHCS) (Title V)

Family/Youth Engagement Partners: About Special Kids and Family Voices Indiana

Clinical Site: Indiana University Department of Pediatrics and Indiana University Health Physicians

Project

The Indiana CoIIN state team is creating a primary-tertiary care team collaborative with the goal of identifying unmet need and improving communication for families involved in three selected primary care practices. These goals are being met through the development and implementation of comprehensive, functional, and fluid Shared Plans of Care in conjunction with nurse care coordination to improve service delivery and quality of care for families.

Outcomes

To date, the Indiana team has built a state Pediatric Complex Care coordination team and initiated nurse care coordination in three primary care practices across the state.


Team Indiana’s journey map illustrated by ConverSketch