scholarly journals Medication safety for children with medical complexity

2020 ◽  
Vol 25 (7) ◽  
pp. 473-473
Author(s):  
Kathleen Huth ◽  
Patricia Vandecruys ◽  
Julia Orkin ◽  
Hema Patel
Keyword(s):  
Health Care ◽  
Medication Errors ◽  
Health Care Professionals ◽  
Chronic Conditions ◽  
Medication Safety ◽  
Care Utilization ◽  
Children With Medical Complexity ◽  
Technology Dependence ◽  
Medical Complexity ◽  
Care Fragmentation

Abstract Due to advances in medical care and innovations in health technology, many children with life-limiting conditions are now living longer. These children are often referred to as ‘children with medical complexity (CMC)’, and they are characterized by chronic conditions, increased health care utilization, and technology dependence. Their complexity of care and inherent fragility lead to higher risk for medication errors, both in-community and in-hospital. High rates of care fragmentation, miscommunication, and polypharmacy in CMC increase opportunities for error, particularly as children transition between health care settings and practitioners. Data on the factors contributing to higher risk of medication errors in this population and how they can be effectively addressed are lacking. This practice point provides clinical guidance for health care professionals to ensure medication safety when caring for CMC, with focus on practical strategies for outpatient and inpatient care.

Hospital Variation in Health Care Utilization by Children With Medical Complexity

PEDIATRICS ◽  
2015 ◽  
Vol 136 (5) ◽  
pp. 860-867 ◽  
Author(s):  
S. L. Ralston ◽  
W. Harrison ◽  
J. Wasserman ◽  
D. C. Goodman
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Care Utilization ◽  
Children With Medical Complexity ◽  
Hospital Variation ◽  
Medical Complexity

Health care utilization and spending among privately insured children with medical complexity

2018 ◽  
Vol 23 (2) ◽  
pp. 213-231 ◽  
Author(s):  
Angela Wangari Walter ◽  
Randall P Ellis ◽  
Yiyang Yuan
Keyword(s):  
Health Care ◽  
Health Care Utilization ◽  
Service Utilization ◽  
Health Plan ◽  
Care Utilization ◽  
Children With Medical Complexity ◽  
Health Maintenance ◽  
Medical Complexity ◽  
Financial Burdens ◽  
Families With Children

Children with medical complexity have high health service utilization and health expenditures that can impose significant financial burdens. This study examined these issues for families with children enrolled in US private health plans. Using IBM Watson/Truven Analytics℠ MarketScan® commercial claims and encounters data (2012–2014), we analyzed through regression models, the differences in health care utilization and spending of disaggregated health care services by health plan types and children’s medical complexity levels. Children in consumer-driven and high-deductible plans had much higher out-of-pocket spending and cost shares than those in health maintenance organizations and preferred provider organizations (PPOs). Children with complex chronic conditions had higher service utilization and out-of-pocket expenditures while having lower cost shares on various categories of services than those without any chronic condition. Compared to families covered by PPOs, those with high-deductible or consumer-driven plans were 2.7 and 1.7 times more likely to spend over US$1000 out of pocket on their children’s medical care, respectively. Families with higher complexity levels were more likely to experience financial burdens from expenditures on children’s medical services. In conclusion, policymakers and families with children need to be cognizant of the significant financial burdens that can arise from children’s complex medical needs and health plan demand-side cost sharing.

Emergency Care of Children with Medical Complexity

2020 ◽  
pp. 603-610
Author(s):  
Christian D. Pulcini ◽  
Annique Hogan ◽  
Eron Friedlaender
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Emergency Care ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Care Utilization ◽  
Care Needs ◽  
Children With Medical Complexity ◽  
Number Of Children ◽  
Medical Complexity

Advancements in pediatric care have led to a significant increase in the number of children living longer (or living into adulthood) with medical complexity. Children with medical complexity are generally defined as those with multiple significant chronic health problems involving multiple organ systems, which result in functional limitations, high health care needs or utilization, and often require need for, or use of, medical technology. Although children with medical complexity represent less than 1% of the pediatric population, they account for a large proportion of health care utilization among children, including acute care and emergency department settings. Many of these children receive a majority of their specialty and outpatient care at tertiary care children’s hospitals, but evidence indicates that 80–90% of encounters for emergency care are at community emergency departments. Furthermore, many of the complex, chronic conditions that characterize children with medical complexity are becoming more clinically relevant to all providers as this subgroup of children mature into adulthood. Therefore, it has and will become increasingly relevant for all emergency providers to be prepared to evaluate and manage what have been traditionally pediatric conditions, technologies, and complications among children in this population. This chapter uses a case-based approach to illustrate more common and challenging patient scenarios when evaluating and treating children with medical complexity in the emergency department.

Home Health Care Utilization in Children With Medicaid

PEDIATRICS ◽  
2022 ◽  
Author(s):  
Sarah A. Sobotka ◽  
David E. Hall ◽  
Cary Thurm ◽  
James Gay ◽  
Jay G. Berry
Keyword(s):  
Health Care ◽  
Home Health Care ◽  
Chronic Conditions ◽  
Chronic Condition ◽  
Home Health ◽  
Care Utilization ◽  
Coding System ◽  
Nursing Assistant ◽  
Children With Medical Complexity ◽  
Technology Assistance

BACKGROUND: Although many children with medical complexity (CMC) use home health care (HHC), little is known about all pediatric HHC utilizers. Our objective was to assess characteristics of pediatric HHC recipients, providers, and payments. METHODS: We conducted a retrospective analysis of 5 209 525 children age 0-to-17 years enrolled Medicaid in the 2016 IBM Watson MarketScan Medicaid Database. HHC utilizers had ≥ 1 HHC claim. Healthcare Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes were reviewed to codify provider types when possible: registered nurse (RN), licensed practical nurse (LPN), home health aide (HHA), certified nursing assistant (CNA), or companion/personal attendant. Enrollee clinical characteristics, HHC provider type, and payments were assessed. Chronic conditions were evaluated with Agency for Healthcare Research and Quality’s Chronic Condition Indicators and Feudtner’s Complex Chronic Conditions. RESULTS: Of the 0.8% of children who used HHC, 43.8% were age <1 year, 25% had no chronic condition, 38.6% had a noncomplex chronic condition, 21.5% had a complex chronic condition without technology assistance, and 15.5% had technology assistance (eg, tracheostomy). HHC for children with technology assistance accounted for 72.6% of all HHC spending. Forty-five percent of HHC utilizers received RN/LPN-level care, 7.9% companion/personal attendant care, 5.9% HHA/CNA-level care, and 36% received care from an unspecified provider. For children with technology assistance, the majority (77.2%) received RN/LPN care, 17.5% companion/personal assistant care, and 13.8% HHA/CNA care. CONCLUSIONS: Children using HHC are a heterogeneous population who receive it from a variety of providers. Future investigations should explore the role of nonnurse caregivers, particularly with CMC.

Navigating the health care system: perceptions of patients with chronic pain

2009 ◽  
Vol 29 (4) ◽  
pp. 162-168
Author(s):  
AL Dewar ◽  
K Gregg ◽  
MI White ◽  
J Lander
Keyword(s):  
Health Care ◽  
Chronic Pain ◽  
Health Care System ◽  
Health Care Professionals ◽  
Primary Care Physicians ◽  
Treatment Compliance ◽  
Care Utilization ◽  
Semistructured Interviews ◽  
The Individual ◽  
Care System

A new framework is needed for patients with chronic pain and their primary care physicians that acknowledges the individual’s experiences and provides evidence-informed education and better linkages to community-based resources. This study describes the experience of 19 chronic-pain sufferers who seek relief via the health care system. Their experiences were recorded through in-depth semistructured interviews and analyzed through qualitative methods. The participants reported early optimism, then disillusionment, and finally acceptance of living with chronic pain. Both individuals with chronic pain and their health care professionals need evidence-informed resources and information on best practices to assist them to manage pain. Empathetic communication between health care professionals and individuals with chronic pain is crucial because insensitive communication negatively affects the individual, reduces treatment compliance and increases health care utilization.

scholarly journals Health care network for chronic conditions: an intervention and evaluation in the health system

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C S Cardoso ◽  
N R Baldoni ◽  
C F Melo ◽  
L O Rezende ◽  
K Noronha ◽  
...  
Keyword(s):  
Health Care ◽  
Health System ◽  
Health Care Professionals ◽  
Chronic Conditions ◽  
Panel Study ◽  
Health Indicators ◽  
Institutional Capacity ◽  
Local Health ◽  
Care Network ◽  
Health Care Network

Abstract Background Health assessments are necessary for the (re) formulation of effective public policies and to guarantee the quality of care offered. This study aim to evaluate the perception of health professionals concerning the institutional capacity of the health system to care for Chronic Conditions (CC) after intervention in a medium-sized municipality in Minas Gerais, Brazil. Methods It is a panel study with evaluation before, during and after an intervention in the health system with a focus on three CC, i.e., i) diabetes; ii) hypertension; and iii) pregnant women. Health care professionals from primary and specialized care units were interviewed using the Assessment of Chronic Illness Care (ACIC) scale, which was applied in nine focal groups organized by health care unit. Results A total of 240 professionals participated of this evaluation, being 94, 63 and 82 participants in 2013, 2015 and 2018 respectively. The ACIC scores showed an positive evolution in the capacity of the health system to care for CC over the years. In the first wave the global score was 5.40 (basic capacity), while in the third wave the score was 9.38 (optimal capacity), with a significant increase in the scores (p < 0.01). Conclusions An important gain in the institutional capacity of the municipality was evidenced for the care of chronic conditions after intervention in the health system. Such an enhancement of the health system to operate in the CC might be sustainable over the time. Furthermore, its impact may directly reflect on the health indicators of the population. Key messages The results showed a strengthening of the local health system. These findings can subsidize other municipalities with a similar reality in the organization of the health care network and, consequently improve the care provided to chronic conditions.

scholarly journals Integrated complex care coordination for children with medical complexity: A mixed-methods evaluation of tertiary care-community collaboration

2021 ◽  
Author(s):  
Eyal Cohen ◽  
Ashley Lacombe-Duncan ◽  
Karen Spalding ◽  
Jennifer MacInnis ◽  
David Nicholas ◽  
...  
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Care Coordination ◽  
Care Center ◽  
Tertiary Care ◽  
Care Utilization ◽  
Complex Care ◽  
Tertiary Care Center ◽  
Community Based ◽  
Children With Medical Complexity

Background Primary care medical homes may improve health outcomes for children with special healthcare needs (CSHCN), by improving care coordination. However, community-based primary care practices may be challenged to deliver comprehensive care coordination to complex subsets of CSHCN such as children with medical complexity (CMC). Linking a tertiary care center with the community may achieve cost effective and high quality care for CMC. The objective of this study was to evaluate the outcomes of community-based complex care clinics integrated with a tertiary care center. Methods A before- and after-intervention study design with mixed (quantitative/qualitative) methods was utilized. Clinics at two community hospitals distant from tertiary care were staffed by local community pediatricians with the tertiary care center nurse practitioner and linked with primary care providers. Eighty-one children with underlying chronic conditions, fragility, requirement for high intensity care and/or technology assistance, and involvement of multiple providers participated. Main outcome measures included health care utilization and expenditures, parent reports of parent- and child-quality of life [QOL (SF-36®, CPCHILD©, PedsQL™)], and family-centered care (MPOC-20®). Comparisons were made in equal (up to 1 year) pre- and post-periods supplemented by qualitative perspectives of families and pediatricians. Results Total health care system costs decreased from median (IQR) $244 (981) per patient per month (PPPM) pre-enrolment to $131 (355) PPPM post-enrolment (p=.007), driven primarily by fewer inpatient days in the tertiary care center (p=.006). Parents reported decreased out of pocket expenses (p<.0001). Parental QOL did not significantly change over the course of the study. Child QOL improved between baseline and 6 months in two PedsQL™ domains [Social (p=.01); Emotional (p=.003)], and between baseline and 1 year in two CPCHILD© domains [Health Standardization Section (p=.04); Comfort and Emotions (p=.03)], while total CPCHILD© score decreased between baseline and 1 year (p=.003). Parents and providers reported the ability to receive care close to home as a key benefit. Conclusions Complex care can be provided in community-based settings with less direct tertiary care involvement through an integrated clinic. Improvements in health care utilization and family-centeredness of care can be achieved despite minimal changes in parental perceptions of child health.

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