Integrated children’s clinic care (ICCC) versus a self-directed care pathway for children with a chronic health condition: a multi-centre randomised controlled trial study protocol

Abstract

BackgroundChildren with chronic health conditions have better health-related outcomes when their care is managed in a personalised and coordinated way. However, increased demand on Australian ambulatory care hospital services has led to longer waitlist times to access specialists and appropriate intervention services; placing vulnerable children at increased risk of poorer short-term (e.g. social difficulties) and long-term (e.g. convictions) health and social outcomes. Traditional approaches to increasing frequency and service of delivery are expensive and can have minimal impact on caregiver burden. A community based service-integration approach, rather than self-directed care is proposed as increased service linkages are more likely to occur and improve the health outcomes of children with a chronic health condition.MethodsAn open, unblinded, multi-centre randomised controlled trial in two Australian public hospitals. 112 children (0–16 years) fulfilling the inclusion criteria will be randomised to one of two clinical pathways for management of their chronic health condition: (1) integrated children’s care clinic (ICCC) or (2) self-directed care pathway. All children and caregivers will be interviewed at 1 week, and 3, 6 and 12 month time intervals. Primary outcome measures include the Pediatric Quality of Life (PedQOL) questionnaire, Subjective Units of Distress Scale, Child Behaviour Checklist (CBCL) and Rotter’s Locus of Control Scale. Secondary outcome measures include the total number of medical appointments, school days missed and quantity of services accessed. Our main objectives are to determine if the ICCC results in better health and economics outcomes compared to the self-directed care pathway.DiscussionThe success of a health systems approach needs to be balanced against clinical, mortality and cost-effectiveness data for long-term sustainability within a publicly funded health system. A clinical pathway that is sustainable, cost-effective, provides efficient evidence-based care and improves the quality of life outcomes for children with chronic health conditions has the potential to reduce waitlist times, improve access to health services, increase consumer satisfaction; and prevent costs associated with poorly managed chronic health conditions into adulthood. This study will be the first to provide clinical and health economics data on an integrated care pathway for the management of chronic health conditions in children. On a broader scale, results from this study will help guide care coordination frameworks for children with chronic health conditions; particularly with the introduction and implementation of a National Disability Insurance Scheme (NDIS) across Australia.Trial registrationAustralia and New Zealand Clinical Trials Register (ANZCTR) ACTRN12617001188325. Registered: 14th August, 2017.Electronic supplementary materialThe online version of this article (10.1186/s12887-018-1034-x) contains supplementary material, which is available to authorized users.

Effect of Care Coordination Using an Allied Health Liaison Officer for Chronic Noncomplex Medical Conditions in Children

“…This multicenter, open label, randomized clinical trial (ACTRN12617001188325) was conducted between October 2017 to October 2020 in pediatric outpatient clinics at 3 Australian public hospitals with tertiary- and secondary-level pediatric care facilities (Queensland Children’s Hospital, Gold Coast University Hospital, and Caboolture Hospital). The trial protocol is given in Supplement 1 and has previously been published . A tertiary pediatric care facility was added to the trial when we received an additional grant in July 2019.…”

Fast track surgery for knee replacement surgery: a lean six sigma approach

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Factors affecting quality of life in children and adolescents with hypermobile Ehlers‐Danlos syndrome/hypermobility spectrum disorders

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