To help with this, a multidisciplinary committee was formed in the spring of 2000, co-chaired by Jody Kurtt, RN, associate director of University of Iowa Children's Hospital, and Jeffrey Lobas, MD, M.P.A., director of Child Health Specialty Clinics.

The committee recommended a de-centralized, family-centered approach to address issues of continuity, communication, and length of stay for children with special health care needs. As a result, the Continuity of Care program began in August 2001.

The program is designed for children from birth to 21 years who have complex medical or behavioral problems expected to last at least one year.

Two pediatric nurse practitioners for the Continuity of Care program, Kris Bonnett, ARNP, and Janine Petitgout, ARNP, identify eligible hospitalized hospitalized patients early in their stay, facilitate their hospital course, and initiate arrangements for a community-based service plan.

"The great part about our job is assuring that patient and family needs are met," said Petitgout. "We are advocates for patients and their families, and we teach them to be advocates for themselves."

In only one year, Continuity of Care has assisted approximately 170 children with special health care needs. "Referrals can be made to the program by anyone–social workers, nursing staff, family members, or other staff," said Petitigout.

By knowing intimately the history of each child’s condition, Petitigout says Continuity of Care provides a more efficient avenue of communication between physicians, nurses, and community providers.

There is also an economic advantage, says Bonnett. "The program decreases the length of stay in the hospital and saves the parents money," she said.