Filling the GAPS: description and evaluation of a primary care intervention for children with chronic health conditions.

OBJECTIVES: Consistent with the "medical home" model, the GAPS program was developed to provide expanded care for children with a range of chronic health conditions within the context of primary care pediatric offices. Parents, pediatricians, and representatives from local Title V agencies participated to assess the child's and family's needs and to identify ways of addressing them. METHODS: Eleven pediatricians in 5 pediatric practices participated in the 4 main activities of the GAPS project: a) needs assessment; b) planning meeting among parents and pediatricians; c) practice-based advisory group; and d) Department of Public Health consultation. A telephone interview of parents and 2 needs assessment questionnaires completed by families were the 2 evaluation methods used. RESULTS: Parents were able to meet desires for "information" and "specific help." Moderate amounts of success were reported for meeting "contact" and "counseling" needs. Parents' explanations of unmet needs included lack of follow-through in obtaining services, unavailability of services, change of mind regarding needs, and pragmatic barriers. Socioeconomic status, the diagnosis and severity of the child's condition, and maternal psychological status were not significant predictors of success in families' ability to get their needs met. CONCLUSIONS: Active collaboration among parents, pediatricians, and Department of Public Health staff helps to ensure comprehensive coordinated care for families of children with chronic health conditions. Considerable challenges remain in implementing effective medical homes.