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.

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.

scholarly journals Epidemiological analysis of hip fractures at a tertiary care center: a retrospective study

2018 ◽  
Vol 4 (4) ◽  
pp. 568
Author(s):  
Madharam Bishnoi ◽  
Tabish Tahir Kirmani ◽  
Najmul Huda ◽  
Gaurav Chahal ◽  
Sandeep Bishnoi
Keyword(s):  
Health Care ◽  
Retrospective Study ◽  
Hip Fractures ◽  
Care Center ◽  
Tertiary Care ◽  
Uttar Pradesh ◽  
The Elderly ◽  
Tertiary Care Center ◽  
Epidemiological Analysis ◽  
Number Of Patients

<p class="abstract"><strong>Background:</strong> Hip fractures are a leading cause of morbidity and mortality in the elderly population posing significant burden on health care resources. The purpose of this study is to determine the epidemiological analysis of hip fractures at a tertiary care center.</p><p class="abstract"><strong>Methods:</strong> This was a retrospective study done on patients with hip fractures admitted during the period 2015-2017 in Moradabad district of Uttar Pradesh. Case files and radiographs of patients were reviewed for age, gender, nature of trauma, associated comorbidities, type of fracture and presence of osteoporosis.<strong></strong></p><p class="abstract"><strong>Results:</strong> During the 2015-2017 period, 2214 patients with hip fractures were admitted, out of which 1180 were males and rest females. The mean age of patients was 56.8 years with 41.6% belonging to age group 60-75 years. In elderly patients, a low energy simple fall accounted for &gt;85% of fractures with presence of significant osteoporosis (Singh’s index grade 3). The in hospital mortality was 2.1%. Hip fracture characteristics included intertrochanteric 57.81%, femoral neck 30.26% and sub trochanteric 11.93%. Smoking and medical comorbidities were present in a significant number of patients.</p><p class="abstract"><strong>Conclusions:</strong> With increased longevity, hip fractures are an increasing health care problem. Various preventive measures for osteoporosis and falls will decline the prevalence of these fractures.</p>

Factors associated with fewer visits for HIV primary care at a tertiary care center in the SoutheAstern U.S.

AIDS Care ◽  
2006 ◽  
Vol 18 (sup1) ◽  
pp. 45-50 ◽  
Author(s):  
Sonia Napravnik ◽  
Joseph J. Eron ◽  
Rosemary G. McKaig ◽  
Amy D. Heine ◽  
Prema Menezes ◽  
...  
Keyword(s):  
Primary Care ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Factors Associated ◽  
Hiv Primary Care

scholarly journals KNOWLEDGE, ATTITUDE AND PRACTICE OF EPILEPSY AMONG HEALTH CARE PROFESSIONALS IN A TERTIARY CARE CENTER IN RAJASTHAN

2015 ◽  
Vol 4 (83) ◽  
pp. 14531-14540 ◽  
Author(s):  
Sureka R K ◽  
Amit Agarwal ◽  
Kuldeep Singh Yadav ◽  
Surbhi Chaturvedi ◽  
Madhu Bijhawan ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Attitude And Practice ◽  
Knowledge Attitude And Practice

scholarly journals Study of pattern of congenital anomalies at tertiary center in Maharashtra, India

2018 ◽  
Vol 7 (7) ◽  
pp. 2802
Author(s):  
B. B. Yadav ◽  
S. B. Yadav ◽  
P. K. Damase
Keyword(s):  
Congenital Anomalies ◽  
Care Center ◽  
Tertiary Care ◽  
Tertiary Care Center ◽  
Second Trimester ◽  
Community Based ◽  
Common Pattern ◽  
Medical College ◽  
Obstetrics And Gynaecology ◽  
Tertiary Center

Background: To highlight common pattern of congenital malformation seen at hospital population of tertiary care center in Maharashtra.Methods: The study was a descriptive prospective study and conducted in the department of obstetrics and gynaecology of government medical college Latur, Maharashtra for a period of six months. Study includes all womens coming for 2nd trimester MTP due to congenital anomalies in foetus and women’s admitted in labour having anomalous foetus. Details of maternal age, parity, type of anomaly present and sex of fetus were noted.Results: Total babies born in the study period were 3482 (including the second trimester abortions). Total babies with congenital abnormality were 75, making the prevalence 2.15%. 10 cases (13.33) had multiple anomalies involving more than one system. The predominant system involved was central nervous system 40 (53.33%) followed by gastrointestinal system 15 (20%). In this study male babies affected more than females.Conclusions: Prevalence of the congenital anomalies will be definitely higher at tertiary care center and to know prevalence in community, more community based studies are required. Increased awareness about preventable risk factors may help in reducing the incidence of congenital anomalies.

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