A National Profile of Caregiver Challenges Among More Medically Complex Children With Special Health Care Needs

Kuo, Dennis Z.; Cohen, Eyal; Agrawal, Rishi; Berry, Jay G.; Casey, Patrick H.

doi:10.1001/archpediatrics.2011.172

Cited by 432 publications

(386 citation statements)

References 38 publications

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“…[41][42][43] For rural families in low-income neighborhoods caring for a recently hospitalized child with chronic illness could lead to additional financial stress, especially if higher out-of-pocket health care expenses are incurred. [44][45][46] Furthermore, some of these areas may not have access to local social work or care management services for help. 47,48 As a result, rural children from economically challenged families may experience difficulties adhering to a discharge care plan, especially a plan that is associated with copayments for medications, equipment, and follow-up visits.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Rural Children Admitted to Pediatric Hospitals

Peltz

White

et al. 2016

Pediatrics

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Section: Discussionmentioning

confidence: 99%

Characteristics of Rural Children Admitted to Pediatric Hospitals

Peltz

White

et al. 2016

Pediatrics

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“…3,5 Medical complexity was accounted for through presence of complex chronic conditions, 19,20 technology assistance, 21 seeing $3 subspecialists, 21,22 length of index stay, and number of hospitalizations and ED visits in the year before enrollment. Additional variables hypothesized to associate with both readmissions and medical home prevalence were included: distance between home and the children's hospital (calculated from zip code), primary care provider (PCP) scope (general pediatrician or subspecialist), and parent confidence to avoid a readmission or ED visit after discharge.…”

Section: Covariatesmentioning

confidence: 99%

The Medical Home and Hospital Readmissions

et al. 2015

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BACKGROUND AND OBJECTIVE: Despite considerable attention, little is known about the degree to which primary care medical homes influence early postdischarge utilization. We sought to test the hypothesis that patients with medical homes are less likely to have early postdischarge hospital or emergency department (ED) encounters.METHODS: This prospective cohort study enrolled randomly selected patients during an acute hospitalization at a children's hospital during 2012 to 2014. Demographic and clinical data were abstracted from administrative sources and caregiver questionnaires on admission through 30 days postdischarge. Medical home experience was assessed by using Maternal and Child Health Bureau definitions. Primary outcomes were 30-day unplanned readmission and 7-day ED visits to any hospital. Logistic regression explored relationships between outcomes and medical home experiences. RESULTS:We followed 701 patients, 97% with complete data. Thirty-day unplanned readmission and 7-day ED revisit rates were 12.4% and 5.6%, respectively. More than 65% did not have a medical home. In adjusted models, those with medical home component "having a usual source of sick and well care" had fewer readmissions than those without (adjusted odds ratio 0.54, 95% confidence interval 0.30-0.96). Readmissions were higher among those with less parent confidence in avoiding a readmission, subspecialist primary care providers, longer length of index stay, and more hospitalizations in the past year. ED visits were associated with lack of parent confidence but not medical home components.CONCLUSIONS: Lacking a usual source for care was associated with readmissions. Lack of parent confidence was associated with readmissions and ED visits. This information may be used to target interventions or identify high-risk patients before discharge. WHAT'S KNOWN ON THIS SUBJECT:Receiving primary care in a high-quality medical home may lead to reductions in hospital or emergency department (ED) utilization; however, the relationship between the medical home and postdischarge hospitalizations and ED visits is poorly understood.WHAT THIS STUDY ADDS: Readmission rates vary markedly based on data source and definition. Unplanned readmissions were associated with absence of a usual source of well and sick care but not other medical home components. Lack of parent confidence at discharge identified patients at high risk for readmissions and ED visits shortly after discharge.

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“…Research on challenges faced by families caring for more medically complex children revealed substantial efforts expended by them on care coordination as well as direct medical care, with the result of financial hardship, compromised gainful employment, and increased stress. 37 Children whose families experience challenges in any or all of these areas are at increased risk for poor health outcomes and increased costs, including expensive permanent institutional care. 50 …”

Section: Value Outside the Doctor's Offi Ce Or Hospitalmentioning

confidence: 99%

Statement of the Problem: Health Reform, Value-Based Purchasing, Alternative Payment Strategies, and Children and Youth With Special Health Care Needs

2017

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There is increasing interest in maximizing health care purchasing value by emphasizing strategies that promote cost-effectiveness while achieving optimal health outcomes. These value-based purchasing (VBP) strategies have largely focused on adult health, and little is known about the impact of VBP program development and implementation on children, especially children and youth with special health care needs (CYSHCN). With the increasing emphasis on VBP, policymakers must critically analyze the potential impact of VBP for CYSCHN, because this group of children, by definition, uses more health care services than other children and inevitably incurs higher per person costs. We provide a history and definition of VBP and insurance design, noting its origin in employer-sponsored health insurance, and discuss various financing and payment strategies that may be pursued under a VBP framework. The relevance of these approaches for CYSHCN is discussed, and recommendations for next steps are provided. There is considerable work to be done if VBP strategies are to be applied to CYSHCN. Issues include the low prevalence of specific special health care need conditions, how to factor in a life course perspective, in which investments in children's health pay off over a long period of time, the marginal savings that may or may not accrue, the increased risk of family financial hardship, and the potential to exacerbate existing inequities across race, class, ethnicity, functional status, and other social determinants of health.

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A National Profile of Caregiver Challenges Among More Medically Complex Children With Special Health Care Needs

Cited by 432 publications

References 38 publications

Characteristics of Rural Children Admitted to Pediatric Hospitals

Characteristics of Rural Children Admitted to Pediatric Hospitals

The Medical Home and Hospital Readmissions

Statement of the Problem: Health Reform, Value-Based Purchasing, Alternative Payment Strategies, and Children and Youth With Special Health Care Needs

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