Hospital-based case management for medically fragile infants: Results of a randomized trial

Gillette, Yvonne; Hansen, Nancy B.; Robinson, Jennifer L.; Kirkpatrick, Kathryn M.; Grywalski, Regina

doi:10.1016/0738-3991(91)90051-6

Cited by 29 publications

(22 citation statements)

References 7 publications

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“…Existing care models include medical homes, comanagement, and hospital-based and hybrid models that focus on care coordination. Reports from several mainly uncontrolled studies have described the medical home, [39][40][41][42] hospital-based programs, 10,24,43 hospitalto-medical home transitions, 22 home care, [44][45][46][47][48] tele-home care, 59 and disease-specific specialty clinics (eg, cystic fibrosis, 50 epilepsy, 51 and sickle cell disease 52 ). Adult providers are also developing adult complex care models.…”

Section: Clinical Agendamentioning

confidence: 99%

Children With Medical Complexity: An Emerging Population for Clinical and Research Initiatives

et al. 2011

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Children with medical complexity (CMC) have medical fragility and intensive care needs that are not easily met by existing health care models. CMC may have a congenital or acquired multisystem disease, a severe neurologic condition with marked functional impairment, and/or technology dependence for activities of daily living. Although these children are at risk of poor health and family outcomes, there are few well-characterized clinical initiatives and research efforts devoted to improving their care. In this article, we present a definitional framework of CMC that consists of substantial family-identified service needs, characteristic chronic and severe conditions, functional limitations, and high health care use. We explore the diversity of existing care models and apply the principles of the chronic care model to address the clinical needs of CMC. Finally, we suggest a research agenda that uses a uniform definition to accurately describe the population and to evaluate outcomes from the perspectives of the child, the family, and the broader health care system. Pediatrics 2011;127:529-538Since 1998, the Maternal and Child Health Bureau has defined children with special health care needs (CSHCN) as those children who have or are at increased risk of a chronic physical, developmental, behavioral, or emotional condition and require health care and related services of a type or amount beyond that required by children generally. 1 An extensive process informed the development of an intentionally broad and inclusive CSHCN definition for the definition to be meaningful for broad program planning and development. Although 13% to 18% of children are considered to have special needs (excluding those who are "at risk" for special needs), 2 there is considerable variation in medical complexity, functional limitations, and resource need among CSHCN. 3,4 One important subgroup is the children who are the most medically fragile and have the most intensive health care needs. Examples vary and include children who have a congenital or acquired multisystem disease, a severe neurologic condition with marked functional impairment, or patients with cancer/cancer survivors with ongoing disability in multiple areas. Terms traditionally used to describe this subgroup include a combination of children with 1 or more of the following terms: complex, chronic, medical, conditions, and/or needs (eg, complex chronic conditions [CCCs], 5 complex medical needs, 6 complex medical conditions, 7 and complex health conditions 8 ), as well as medically complex children. 9,10 In this article, we use the term "children with medical complexity" (CMC). The rationales are that it uses "person-first" terminology and refers to the extra time, expertise, and resources necessary to achieve optimal health outcomes for these children. AUTHORS:

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Section: Clinical Agendamentioning

confidence: 99%

Children With Medical Complexity: An Emerging Population for Clinical and Research Initiatives

et al. 2011

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“…Three trials had inclusion criteria that specified a disease state, such as bronchopulmonary dysplasia or cranial abnormalities (that is, grade III/IV intraventricular hemorrhage and/or periventricular leukomalacia). 61,68,73 Finally, there were study variations in the socioeconomic status of parents, where two studies (Widmayer et al 77 and Brown et al 58 ) selected only preterms born to teenaged, lower socioeconomic status, black teenage mothers.…”

Section: Identification Of Relevant Studiesmentioning

confidence: 99%

“…Only three of the included studies specifically studied high-risk infants. 61,68,73 Data were only available at 6 and 12 months for meta-analysis. A similar range of effects was found, where in general positive findings in the BSID-MDI outweighed the effects in the BSID-PDI (see Table 2).…”

Section: Identification Of Relevant Studiesmentioning

confidence: 99%

Early interventions involving parents to improve neurodevelopmental outcomes of premature infants: a meta-analysis

et al. 2009

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Objective: To determine in a systematic review, whether interventions for infant development that involve parents, improve neurodevelopment at 12 months corrected age or older.Study Design: Randomized trials were identified where an infant intervention was aimed to improve development and involved parents of preterms; and long-term neurodevelopment using standardized tests at 12 months (or longer) was reported.Result: Identified studies (n ¼ 25) used a variety of interventions including parent education, infant stimulation, home visits or individualized developmental care. Meta-analysis at 12 months (N ¼ 2198 infants) found significantly higher mental (N ¼ 2198) and physical (N ¼ 1319) performance scores favoring the intervention group. At 24 months, the mental (N ¼ 1490) performance scores were improved, but physical (N ¼ 1025) performance scores were not statistically significant. The improvement in neurodevelopmental outcome was not sustained at 36 months (N ¼ 961) and 5 years (N ¼ 1017). Conclusion:Positive clinically meaningful effects (>5 points) are seen to an age of 36 months, but are no longer present at 5 years.

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“…The infants and families in the high-intensity service group also received services from a multidisciplinary team. These services included predischarge hospital visits, Individualized Family Service Plan (IFSP) development and implementation, and coordinated office and home-based early intervention services (Gillette, 1992;Gillette, Hansen, Robinson, Grywalski, & Kirkpatrick, 1991a, 1991b.…”

Section: Methodsmentioning

confidence: 99%

Does More Intensive Neonatal Intensive Care Unit Follow-Up Service Result in Better Outcomes? A Cost-Effective Analysis

Goetze¹,

Immel²,

Escobar³

et al. 1993

Early Education & Development

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Hospital-based case management for medically fragile infants: Results of a randomized trial

Cited by 29 publications

References 7 publications

Children With Medical Complexity: An Emerging Population for Clinical and Research Initiatives

Children With Medical Complexity: An Emerging Population for Clinical and Research Initiatives

Early interventions involving parents to improve neurodevelopmental outcomes of premature infants: a meta-analysis

Does More Intensive Neonatal Intensive Care Unit Follow-Up Service Result in Better Outcomes? A Cost-Effective Analysis

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