A Medical Home Center: Specializing in the Care of Children with Special Health Care Needs of High Intensity

Kelly, Anne; Golnik, Allison; Cady, Rhonda

doi:10.1007/s10995-007-0271-7

Cited by 52 publications

(46 citation statements)

References 14 publications

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“…Proposed approaches include care teams and specialty medical homes that collaborate with primary care physicians. 26,27 Physicians reported that the medical home components of family trust and satisfaction were lower among families of children with autism than other medical conditions. These results resonate with those of parents of children with autism, who provided poorer assessments of their physicians' abilities to answer questions, manage their child's condition, and understand how the child's condition affected the family compared with parents of children with other special health care needs.…”

Section: Discussionmentioning

confidence: 99%

Medical Homes for Children With Autism: A Physician Survey

2009

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Section: Discussionmentioning

confidence: 99%

Medical Homes for Children With Autism: A Physician Survey

2009

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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%

“…21 The need to coordinate care for CMC has been underscored by the recent emergence of numerous novel complex care programs across North America that address the service needs of CMC in a variety of inpatient, outpatient, and community-based settings. 10,[22][23][24] However, meaningful evaluation of the outcomes of these and other programs is limited by a lack of agreement on a definition of CMC and the absence of a clinical and research agenda. The objectives of this article are to (1) present a definitional framework for describing CMC and (2) propose a clinical and research agenda for a model of service delivery that is aimed at improving the quality of health care for CMC and their families.…”

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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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“…Several groups have described their experience improving the management of such patients clustered around specialized children's hospitals, each reporting some measure of decreased resource utilization associated with their program. [14][15][16][17][18][19] One group further described their experience of moving the locus of care into community hospitals, achieving further cost savings. 19 As these programs disseminate, the ability to compare their approaches, outcomes, and resource utilization between centers using populationbased data would help every center identify best practices sooner.…”

Section: Figurementioning

confidence: 99%

Hospital Variation in Health Care Utilization by Children With Medical Complexity

et al. 2015

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BACKGROUND: Although children with medical complexity have high health care needs, little is known about the variation in care provided between centers. This information may be particularly useful in identifying opportunities to improve quality and reduce costs. METHODS:We conducted a retrospective population-based observational cohort study using all payer claims databases for children aged 30 days to ,18 years residing in Maine, New Hampshire, and Vermont from 2007 to 2010. We identified hospital-affiliated cohorts (n = 6) of patients (n = 8216) with medical complexity by using diagnostic codes from both inpatient and outpatient claims. Children were assigned to the hospital where they received the most inpatient days, or their outpatient visits if no hospitalization occurred. Outcomes of interest included patient encounters, medical imaging, and diagnostic testing. Adjusted relative rates were calculated with overdispersed Poisson regression models.RESULTS: Adjusting for patient characteristics, the number of inpatient (relative rate 0.84 vs 2.28) and intensive care days (relative rate 0.45 vs 1.28) varied by more than twofold, whereas office (relative rate 0.77 vs 1.12) and emergency department visits (relative rate 0.71 vs 1.37) varied to a lesser extent. There was also marked variation in the use of imaging, and other diagnostic tests, with particularly high variation in electrocardiography (relative rate 0.35 vs 2.81) and head MRI (relative rate 0.72 vs 2.12).CONCLUSIONS: Depending on where they receive care, children with medical complexity experience widely different patterns of utilization. These findings indicate the need for identifying best practices for this growing patient population.WHAT'S KNOWN ON THIS SUBJECT: Children with medical complexity require a disproportionate amount of health services due to a multitude of chronic severe illness, and their impact on the health care system appears to be increasing. WHAT THIS STUDY ADDS:This study provides one of the first comparisons of health care utilization patterns for children with medical complexity between medical centers in a population-based cohort.

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A Medical Home Center: Specializing in the Care of Children with Special Health Care Needs of High Intensity

Cited by 52 publications

References 14 publications

Medical Homes for Children With Autism: A Physician Survey

Medical Homes for Children With Autism: A Physician Survey

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

Hospital Variation in Health Care Utilization by Children With Medical Complexity

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