A Tertiary Care–Primary Care Partnership Model for Medically Complex and Fragile Children and Youth With Special Health Care Needs

Gordon, John B.; Colby, Holly; Bartelt, Tera; Jablonski, Debra; Krauthoefer, Mary L.; Havens, Peter L.

doi:10.1001/archpedi.161.10.937

Cited by 197 publications

(204 citation statements)

References 19 publications

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“…Five studies 15,25,[37][38][39] assessed various principles from the American Academy of Pediatrics (AAP) medical home model, in particular coordination, accessibility, and family-centeredness. In a broad sample of 43 primary care practices with varying levels of success achieving the medical home principles measured by Medical Home Index (MHI) score, fewer overall hospitalizations were observed in practices with higher MHI scores (specifically higher levels of organizational capacity, data management, chronic condition management, and care coordination).…”

Section: Medical Home Characteristics Organizational Capacitymentioning

confidence: 99%

Preventing Hospitalizations in Children With Medical Complexity: A Systematic Review

et al. 2014

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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 (1) studies characterizing potentially preventable hospitalizations in CMC and (2) 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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Section: Medical Home Characteristics Organizational Capacitymentioning

confidence: 99%

Preventing Hospitalizations in Children With Medical Complexity: A Systematic Review

et al. 2014

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“…46 Applying a medical home model to the inpatient setting with coordination and communication between hospital caregivers, primary care providers, and specialists is challenging but has been suggested as beneficial to the child, the hospital, and caregivers. 47,48 Additional research should confirm the value of a hospitalbased medical home.…”

Section: Figurementioning

confidence: 99%

Increasing Prevalence of Medically Complex Children in US Hospitals

et al. 2010

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OBJECTIVE: In this study we used national data to determine changes in the prevalence of hospital admissions for medically complex children over a 15-year period. PATIENTS AND METHODS: Data from the Nationwide Inpatient Sample, a component of the Healthcare Cost and Utilization Project, was analyzed in 3-year increments from 1991 to 2005 to determine national trends in rates of hospitalization of children aged 8 days to 4 years with chronic conditions. Discharge diagnoses from the Nationwide Inpatient Sample were grouped into 9 categories of complex chronic conditions (CCCs). Hospitalization rates for each of the 9 CCC categories were studied both individually and in combination. Trends of children hospitalized with 2 specific disorders, cerebral palsy (CP) and bronchopulmonary dysplasia, with additional diagnoses in more than 1 CCC category were also examined. RESULTS: Hospitalization rates of children with diagnoses in more than 1 CCC category increased from 83.7 per 100 000 (1991–1993) to 166 per 100 000 (2003–2005) (P[r] < .001). The hospitalization rate of children with CP plus more than 1 CCC diagnosis increased from 7.1 to 10.4 per 100 000 (P = .002), whereas the hospitalization rates of children with bronchopulmonary dysplasia plus more than 1 CCC diagnosis increased from 9.8 to 23.9 per 100 000 (P < .001). CONCLUSIONS: Consistent increases in hospitalization rates were noted among children with diagnoses in multiple CCC categories, whereas hospitalization rates of children with CP alone have remained stable. The relative medical complexity of hospitalized pediatric patients has increased over the past 15 years.

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“…8 Some of these programs have reported a major impact on health care utilization and costs, suggesting that they may help interrupt the cycle of persistent health care spending that the children would have experienced otherwise. [9][10][11][12][13] As for their adult counterparts, 14 hospital care is a significant contributor to the overall cost accrued by children with chronic conditions. 2,5,6 Many children who experience high health care costs incur frequent hospital admissions and lengthy hospitalizations.…”

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confidence: 99%

Hospital Utilization Among Children With the Highest Annual Inpatient Cost

et al. 2016

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BACKGROUND AND OBJECTIVES: Children who experience high health care costs are increasingly enrolled in clinical initiatives to improve their health and contain costs. Hospitalization is a significant cost driver. We describe hospitalization trends for children with highest annual inpatient cost (CHIC) and identify characteristics associated with persistently high inpatient costs in subsequent years.

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A Tertiary Care–Primary Care Partnership Model for Medically Complex and Fragile Children and Youth With Special Health Care Needs

Abstract: This tertiary care-primary care partnership model improved health care and reduced costs with relatively modest institutional support.

Cited by 197 publications

References 19 publications

Preventing Hospitalizations in Children With Medical Complexity: A Systematic Review

Preventing Hospitalizations in Children With Medical Complexity: A Systematic Review

Increasing Prevalence of Medically Complex Children in US Hospitals

Hospital Utilization Among Children With the Highest Annual Inpatient Cost

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