A Care Model for Children with Complex Medical Needs
August 8, 2013 04:03 PM
The Children’s Hospital Association issued a special report that examines children with medical complexities (CMC) and the gaps that currently exist in meeting the needs of these children.
The report, The Landscape of Medical Care for Children with Medical Complexities, distinguishes children with complex medical needs from those with special needs in that CMC have more intensive health care needs. Although our health care system has been designed to meet the needs of special needs children they do not adequately meet the needs of children with medical complexities.
As a result, care for this unique pediatric population is often fragmented, uncoordinated, crisis-driven and has a tendency to over-medicalize - while failing to support the family and caregivers.
The report outlines three key areas needed for reform:
Clear definitions of who CMC are, and what are their core health care needs;
Identification of what evidence-based care processes have the greatest impact on their health and functional outcomes; and
Determination of what amount of cost savings, if any, might be achievable with improved health care delivery.
Although there is no standard definition of medical complexity, four cardinal domains characterize CMC:
Chronic, severe health conditions;
Substantial health service needs;
Major functional limitations;
High health resource utilization.
CMC likely represent less than 1% of all children, yet they account for over one-third of pediatric health care costs. Inpatient care is responsible for as much as 80% of health care cost for CMC and use of the hospital is increasing for CMC over time. It is hypothesized that some inpatient utilization for CMC could be avoided with better ambulatory care.
The ideal model of care for CMC is suspected to be one that:
Provides urgent care in the outpatient setting to treat acute health problems;
Contains at least one outpatient provider who comprehensively addresses acute and chronic medical, functional and psychosocial needs;
Coordinates decision making among all participating health care providers;
Develops effective, proactive plans of care to maximize the child’s well-being and proactively anticipates health problems that are likely to occur.
Pediatric home care providers routinely provide care to children with complex medical needs using components of the care model outlined in the report. The holistic approach to care delivery that is inherent in home health care will allow pediatric home care providers to be valuable partners with other community providers striving to provide adequate care to CMC.
The Pediatric Home Care Association of America, a NAHC affiliate, values the research and ideas in the report and will continue to advocate for the children in the community and for these medically fragile children.
To view the entire report click here.
The Landscape of Medical Care for Children with Medical Complexities.
Jay G. Berry, MD, MPH;1 Rishi K. Agrawal, MD, MPH;2 Eyal Cohen, MD, MSc;3 Dennis Z. Kuo, MD, MHS4
1 Boston Children’s Hospital, Harvard Medical School, Boston, MA;2 Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University School of Medicine, Chicago, IL
3 The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
4 Arkansas Children’s Hospital, University of Arkansas for Medical Sciences, Little Rock, AR