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| Complex Web of Care for one CMC |
Increasing efficiency and effectiveness of care for CMC could have significant systemic payoff.
Patterns and costs of health care use of children with medical comp... - PubMed - NCBI
Health care use of children with medical complexity (CMC), such as those with neurologic impairment or other complex chronic conditions (CCCs) and those with technology assistance (TA), is not well understood. The objective of the study was to evaluate health care utilization and costs in a population-based sample of CMC in Ontario, Canada.
Landscape of Medical Care for CMC
Children with medical complexity (CMC) are an important group of children who have multifaceted clinical and functional needs that can be challenging to manage and treat in the current health care system. Although there is no standard definition of medical complexity, four cardinal domains characterize CMC:
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.
Care for many CMC is currently fragmented, uncoordinated, and crisis-driven with a tendency to overmedicalize the child and to under-support the child’s family caregivers. Several single-centered, quality improvement studies of outpatient care for CMC report a reduction in inpatient utilization. However, most of these studies have designs that can neither determine causality nor quantify the true amount of cost savings attributable to improved quality of care.
Preventing Hospitalizations in CMC
Preventing Hospitalizations in Children with Medical Complexity: A Systematic Review | RANDPreventing Hospitalizations in Children With Medical Complexity: A Systematic Review
BACKGROUND AND OBJECTIVES:
Children with medical complexity (CMC) account for disproportionately high hospital use, and it is unknown if hospitalizations may be prevented. Our objective was to summarize evidence from
- studies characterizing potentially preventable hospitalization in CMC and
- interventions aiming to reduce such hospitalizations.
METHODS:
Our data sources include
- Medline,
- Cochrane Central Register of Controlled Trials,
- Web of Science, and
- Cumulative Index to Nursing and Allied Health Literature databases
from their originations, and- hand search of article bibliographies.
Observational studies (n = 13) characterized potentially preventable hospitalizations, and experimental studies (n = 4) evaluated the efficacy of interventions to reduce them. Data were extracted on patient and family characteristics, medical complexity and preventable hospitalization indicators, hospitalization rates, costs, and days. Results of interventions were summarized by their effect on changes in hospital use.RESULTS:
Preventable hospitalizations were measured in 3 ways:
- ambulatory care sensitive conditions,
- readmissions, or
- investigator-defined criteria.
Postsurgical patients, those with neurologic disorders, and those with medical devices had higher preventable hospitalization rates, as did those with public insurance and nonwhite race/ethnicity. Passive smoke exposure, nonadherence to medications,
and lack of follow-up after discharge were additional risks. Hospitalizations for ambulatory care sensitive conditions were less common in more complex patients. Patients receiving home visits, care coordination, chronic care-management, and
continuity across settings had fewer preventable hospitalizations.
CONCLUSIONS:
There were a limited number of published studies. Measures for CMC and preventable hospitalizations were heterogeneous. Risk of bias was moderate due primarily to limited
controlled experimental designs. Reductions in hospital use among CMC might be possible. Strategies should target primary drivers of preventable hospitalizations.
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