{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:23:15Z","timestamp":1760188995226,"version":"3.40.5"},"reference-count":14,"publisher":"American Academy of Pediatrics (AAP)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2008,8,1]]},"abstract":"<jats:p>OBJECTIVE. The purpose of this work was to examine pediatricians' and endocrinologists' views about management for routine preventive and acute care, diabetes-specific care, and family education and care coordination for children with insulin-dependent diabetes.<\/jats:p>\n               <jats:p>METHODS. We conducted a mixed-mode survey of all of the pediatricians in 1 medicaid managed care network and all of the pediatric and adult endocrinologists who treat children with diabetes in North Carolina.<\/jats:p>\n               <jats:p>RESULTS. Of the 201 pediatricians surveyed, 132 responded (65%). Among the 61 endocrinologists who treat children, 59% replied. Nearly all of the respondents agreed that primary care physicians should have responsibility for routine primary care (eg, well-child checkups, treating minor illnesses or injuries, and immunizations). Likewise, large majorities favored endocrinologists as leads for diabetes-specific care (eg, 94% for training in use of an insulin pump and 82% for training in use of a glucometer). Many generalists and subspecialists reported that specific aspects of diabetes care should be comanaged (eg, 31% for tracking of hemoglobin A1c). However, large proportions of pediatricians and endocrinologists expressed differing opinions about the primary responsibility for family education and care coordination and for specific diabetes services. For example, 80% of endocrinologists saw subspecialists as leads for monitoring blood sugar levels, whereas 52% of pediatricians favored comanagement.<\/jats:p>\n               <jats:p>CONCLUSIONS. An effective medical home model of care depends on establishing clear lines of responsibility between the primary care physician and subspecialist. Our findings suggest that primary care physicians and subspecialists agree on who should lead most aspects of care for patients with insulin-dependent diabetes and that some aspects of care should be comanaged. However, primary care physicians and subspecialists did not agree either between or within disciplines on who should be more responsible for the basic aspect of monitoring of blood sugar levels. Approaches that recognize the appropriate division of care between primary care physicians and subspecialists, facilitate comanagement when it is needed, and reward the collaboration required to provide medical homes for patients should be investigated as models of care.<\/jats:p>","DOI":"10.1542\/peds.2007-3761","type":"journal-article","created":{"date-parts":[[2008,8,1]],"date-time":"2008-08-01T13:38:30Z","timestamp":1217597910000},"page":"e383-e387","source":"Crossref","is-referenced-by-count":14,"title":["A Medical Home for Children With Insulin-Dependent Diabetes: Comanagement by Primary and Subspecialty Physicians\u2014Convergence and Divergence of Opinions"],"prefix":"10.1542","volume":"122","author":[{"given":"Steven E.","family":"Wegner","sequence":"first","affiliation":[{"name":"AccessCare, Morrisville, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christine R.","family":"Lathren","sequence":"additional","affiliation":[{"name":"North Carolina Department of Medical Assistance, Office of Rural Health, Raleigh, North Carolina"},{"name":"Department of Pediatrics, North Carolina Children's Hospital, Chapel Hill, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles G.","family":"Humble","sequence":"additional","affiliation":[{"name":"AccessCare, Morrisville, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle L.","family":"Mayer","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Administration, University of North Carolina-Chapel Hill School of Public Health, Chapel Hill, North Carolina"},{"name":"Cecil G. Sheps Center for Health Services Research, Chapel Hill, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Feaganes","sequence":"additional","affiliation":[{"name":"AccessCare, Morrisville, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan D.","family":"Stiles","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, North Carolina Children's Hospital, Chapel Hill, North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"417","published-online":{"date-parts":[[2008,8,1]]},"reference":[{"key":"2021120905592719700_R1","doi-asserted-by":"crossref","unstructured":"American Academy of Pediatrics, Medical Home Initiatives for Children With Special Needs Project Advisory Committee. The medical home. Pediatrics.\u20082002;110(1 pt 1):184\u2013186","DOI":"10.1542\/peds.110.1.184"},{"key":"2021120905592719700_R2","doi-asserted-by":"crossref","unstructured":"McPherson M, Honberg L. Identification of children with special health care needs: a cornerstone of achieving Healthy People 2010. Ambul Pediatr.\u20082001;2(1):22\u201323","DOI":"10.1367\/1539-4409(2002)002<0022:IOCWSH>2.0.CO;2"},{"key":"2021120905592719700_R3","unstructured":"US Department of Health and Human Services. Delivering on the Promise. Washington, DC: US Department of Health and Human Services; 2002"},{"key":"2021120905592719700_R4","unstructured":"Maternal and Child Health Bureau. Achieving and measuring success: a national agenda for children with special needs. Available at: http:\/\/mchb.hrsa.gov\/programs\/specialneeds\/measuresuccess.htm. Accessed November 6, 2007"},{"key":"2021120905592719700_R5","unstructured":"American Academy of Family Physicians; American Academy of Pediatrics; American College of Physicians; American Osteopathic Association. Joint Principles of the Patient Centered Medical Home. Elk Grove Village, IL: American Academy of Pediatrics; 2007"},{"key":"2021120905592719700_R6","unstructured":"Federal Expert Work Group on Pediatric Subspecialty Capacity. Promising Approaches for Strengthening the Interface Between Primary and Specialty Pediatric Care. Washington, DC: Maternal and Child Health Policy Research Center, March 2006"},{"key":"2021120905592719700_R7","unstructured":"Antonelli RC, Stille CJ, Freeman LC. Enhancing Collaboration Between Primary and Subspecialty Care Providers for Children and Youth With Special Health Care Needs. Washington, DC: Georgetown University Center for Child and Human Development; 2005"},{"key":"2021120905592719700_R8","doi-asserted-by":"crossref","unstructured":"Stille CJ, Jerant A, Bell D, Meltzer D, Elmore JG. Coordinating care across diseases, settings, and clinicians: a key role for the generalist in practice. Ann Intern Med.\u20082005;142(8):700\u2013708","DOI":"10.7326\/0003-4819-142-8-200504190-00038"},{"key":"2021120905592719700_R9","doi-asserted-by":"crossref","unstructured":"SEARCH for Diabetes in Youth Study Group; Liese AD, D'Agostino RB Jr, et al. The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for diabetes in youth study. Pediatrics.\u20082006;118(4):1510\u20131518","DOI":"10.1542\/peds.2006-0690"},{"key":"2021120905592719700_R10","doi-asserted-by":"crossref","unstructured":"Diabetes Control and Complications Trial Research Group. Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes control and complications trial. J Pediatr.\u20081994;125(2):177\u2013188","DOI":"10.1016\/S0022-3476(94)70190-3"},{"key":"2021120905592719700_R11","unstructured":"Rural Health Research Center, University of Washington. Rural-urban commuting area codes (version 2.0). Available at: http:\/\/depts.washington.edu\/uwruca. Accessed February 25, 2008."},{"key":"2021120905592719700_R12","doi-asserted-by":"crossref","unstructured":"Forrest CB, Glade GB, Baker AE, Bocian AB, Kang M, Starfield B. The pediatric primary-specialty care interface: how pediatricians refer children and adolescents to specialty care. Arch Pediatr Adolesc Med.\u20081999;153(7):705\u2013714","DOI":"10.1001\/archpedi.153.7.705"},{"key":"2021120905592719700_R13","doi-asserted-by":"crossref","unstructured":"Stille CJ, McLaughlin TJ, Primack WA, Mazor KM, Wasserman RC. Determinates and impact of generalist-specialist communication about pediatric outpatient referrals. Pediatrics.\u20082006;118(4):1341\u20131349","DOI":"10.1542\/peds.2005-3010"},{"key":"2021120905592719700_R14","doi-asserted-by":"crossref","unstructured":"Mayer ML. Are we there yet? Distance to care and relative supply among pediatric medical subspecialties. Pediatrics.\u20082006;118(6):2313\u20132321","DOI":"10.1542\/peds.2006-1570"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/122\/2\/e383\/1034488\/zpe0080800e383.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/122\/2\/e383\/1034488\/zpe0080800e383.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T00:01:10Z","timestamp":1639094470000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/122\/2\/e383\/73068\/A-Medical-Home-for-Children-With-Insulin-Dependent"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2008,8,1]]},"references-count":14,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2008,8,1]]},"published-print":{"date-parts":[[2008,8,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2007-3761","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"type":"print","value":"0031-4005"},{"type":"electronic","value":"1098-4275"}],"subject":[],"published":{"date-parts":[[2008,8,1]]}}}