Children With Medical Complexity: The 10-Year Experience of a Single Center

Murphy, Nancy; Alvey, Justin; Valentine, Karen; Mann, Kilby; Wilkes, Jacob; Clark, Edward B.

doi:10.1542/hpeds.2020-0085

Cited by 25 publications

(12 citation statements)

References 37 publications

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“…Several studies have described benefits of care coordination programs for preventing rehospitalization risk among children with medical complexity. In a 10-year review of one care coordination program, Murphy et al 20 found that this program was associated with reduced ED visits, hospital admissions, and total hospital cost. Partners for Kids, an Accountable Care Organization at Nationwide Children’s Hospital in Central Ohio, also demonstrated that care coordination was associated with reduced hospital readmissions, total bed days, and visits to the ED.…”

Section: Discussionmentioning

confidence: 99%

Outpatient Follow-up Care After Hospital Discharge of Children With Complex Chronic Conditions at a Rural Tertiary Care Hospital

Brown

Quaile

Morris

et al. 2021

Clin Pediatr (Phila)

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Objective To determine factors associated with completion of recommended outpatient follow-up visits in children with complex chronic conditions (CCCs) following hospital discharge. Methods We retrospectively identified children aged 1 to 17 years diagnosed with a CCC who were discharged from our rural tertiary care children’s hospital between 2017 and 2018 with a diagnosis meeting published CCC criteria. Patients discharged from the neonatal intensive care unit and patients enrolled in a care coordination program for technology-dependent children were excluded. Results Of 113 eligible patients, 77 (68%) had outpatient follow-up consistent with discharge instructions. Intensive care unit (ICU) admission ( P = .020) and prolonged length of stay ( P = .004) were associated with decreased likelihood of completing recommended follow-up. Conclusions Among children with CCCs who were not already enrolled in a care coordination program, ICU admission was associated with increased risk of not completing recommended outpatient follow-up. This population could be targeted for expanded care coordination efforts.

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Section: Discussionmentioning

confidence: 99%

Outpatient Follow-up Care After Hospital Discharge of Children With Complex Chronic Conditions at a Rural Tertiary Care Hospital

Brown

Quaile

Morris

et al. 2021

Clin Pediatr (Phila)

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“…Our results did not differ from the ones reported by Murphy et al who described a sample of CMC in PPC with a median of fourorgan systems involved. 17 Lower age at symptoms onset is significantly associated with the higher number of medical devices registered.…”

Section: Functional Limitations and Technology Dependencementioning

confidence: 99%

Children with medical complexity and pediatric palliative care: Data by a respiratory intermediate care unit

Caggiano

Pavone

Cherchi

et al. 2022

Pediatric Pulmonology

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Pediatric palliative care (PPC) is an active and total approach to the care of children with life‐limiting conditions and their families. PPC programs provide ongoing treatment for children with medical complexity (CMC), many of whom will reach adulthood. Aim of the study was to describe a population of CMC attendingin six preselected months the Respiratory Intermediate Care Unit of a tertiary referral hospital for southern and central Italy. We enrolled all CMC patients admitted to our unit in six preselected months and registered pathologies and different categories of childhood diseases, devices and needs, hospitalization and home care plan. Among the 275 children admitted to our unit, 130 CMC were included. Median age was 9.9 (0.1–40.0) years. The main pathologies recorded were neuromuscular, neurological, respiratory, metabolic and malformative diseases, genetic syndromes and outcomes of prematurity. Comorbidity due to respiratory, digestive, neurological, cardiac and urological involvement was present in a high percentage of cases. Among our patients, only 46 were not carriers of any medical device. The average length of hospitalization was 7.0 (1.0–270.0) days with 2 (1.0–7.0) admissions per year per patient. Home care activation was not required for 47 out of 130 patients. Children eligible for PPC are increasing and their survival results in a rise of comorbidities and special needs demanding multilevel interventions. Respiratory symptoms are the most recurrent ones observed, thus requiring an expert in PPC with expertise in the respiratory field. Sharing data and knowledge of CMC needs may help improve care coordination.

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“…Children born extremely prematurely (<27 weeks gestation), for example, typically have complex medical needs and spend the first several months of their critical newborn development hospitalized in the neonatal intensive care unit (NICU) (Nankervis et al, 2010). CMC comprise 1%–3% of the US population (Coller et al, 2016; Murphy et al, 2020; Yu et al, 2021) but account for up to 40% of paediatric hospital expenditures (Berry et al, 2014; Simon et al, 2010). They incur nine times more inpatient visits than children without special healthcare needs (Kuo et al, 2015).…”

Section: Introductionmentioning

confidence: 99%

Time‐motion observations to characterize the developmental environment in a paediatric post‐acute care hospital

Hogan,

Wallace,

Schaffer‐Nay

et al. 2023

Child

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BackgroundChronically hospitalized children are at risk for neurodevelopmental delay, compounded by restricted social interactions, movement and environmental stimulation. We measured patients' movements and interactions to characterize developmentally relevant aspects of our inpatient environment and identify opportunities for developmental enrichment.MethodsAs part of a quality improvement initiative to inform neurodevelopmental programming for children with medical complexity at our paediatric post‐acute care specialty hospital, we conducted >232 hours of time‐motion observations. Trained observers followed 0‐ to 5‐year‐old inpatients from 7 am to 7 pm on weekdays, categorizing observations within five domains: Where, With, Position, State and Environment. Observations were collected continuously utilizing REDCap on iPads. A change in any domain initiated a new observation.ResultsPatients were median 1 year and 8 months of age (range 2 months to 3 years 9 months) with a median length of hospitalization of 514 days (range 66–1298). In total, 2636 unique observations (or median 134 observations per patient‐day [range 95–210]) were collected. Patients left their rooms up to 4 times per day for median 1 h and 34 min (range 41 min to 4 h:30 min). Patients spent 4 h:6 min (2 h:57 min to 6 h:30 min) interacting with someone and 3 h:51 min (57 min to 6 h:36 min) out of bed each day. Patients were simultaneously out of their beds, interacting with someone and awake for 2 h:21 min (51 min to 4 h:19 min) each day.ConclusionsDespite a care model prioritizing time out of bed and social interaction, time‐motion observations indicate patients spent many of their waking hours in bed and alone. Quantifying our inpatients developmental opportunities will inform neurodevelopmental programming initiatives.

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Children With Medical Complexity: The 10-Year Experience of a Single Center

Cited by 25 publications

References 37 publications

Outpatient Follow-up Care After Hospital Discharge of Children With Complex Chronic Conditions at a Rural Tertiary Care Hospital

Outpatient Follow-up Care After Hospital Discharge of Children With Complex Chronic Conditions at a Rural Tertiary Care Hospital

Children with medical complexity and pediatric palliative care: Data by a respiratory intermediate care unit

Time‐motion observations to characterize the developmental environment in a paediatric post‐acute care hospital

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