Hospital-Based Comprehensive Care Programs for Children With Special Health Care Needs

Abstract

To examine the effectiveness of hospitalbased comprehensive care programs in improving the quality of care for children with special health care needs. Data Sources: A systematic review was conducted using Ovid MEDLINE, CINAHL, EMBASE, PsycINFO, Sociological Abstracts SocioFile, and Web of Science.Study Selection: Evaluations of comprehensive care programs for categorical (those with single disease) and noncategorical groups of children with special health care needs were included. Selected articles were reviewed independently by 2 raters.Data Extraction: Models of care focused on comprehensive care based at least partially in a hospital setting. The main outcome measures were the proportions of studies demonstrating improvement in the Institute of Medicine's quality-of-care domains (effectiveness of care, efficiency of care, patient or family centeredness, patient safety, timeliness of care, and equity of care).Data Synthesis: Thirty-three unique programs were included, 13 (39%) of which were randomized controlled

Variation in Child Health Care Utilization by Medical Complexity

“…This care oversight may be delivered by a primary care-based Medical Home, a tertiary care center-based comprehensive care service, or both under a co-management agreement. 3,24 Interventions to reduce the cost and family burdens of CMC may include enhancing care coordination, 25 improving transitions from hospital to home, 5 and enrolling CMC into hospital-based comprehensive care services. 24 The latter approach has resulted in some success reducing hospitalizations and overall costs.…”

“…3,24 Interventions to reduce the cost and family burdens of CMC may include enhancing care coordination, 25 improving transitions from hospital to home, 5 and enrolling CMC into hospital-based comprehensive care services. 24 The latter approach has resulted in some success reducing hospitalizations and overall costs. 11–13,21 However, CMC in our national data set averaged fewer than one hospitalization per year, limiting the impact of reducing hospitalizations.…”

Hospital Utilization Among Children With the Highest Annual Inpatient Cost

“…It is believed that some of the hospital costs incurred by these patients might have been avoided with better quality of care and better care coordination. 20,21 However, there is little information on longitudinal trends in hospital costs for children and on the predictors of persistently high hospital costs. 2,21 Without this information, it is difficult to target the correct patients to help and to discern the true impact of interventions.…”

Recognition and Management of Medical Complexity

“…63 Compared with the traditional primary care setting, hospital-based complex care clinics may be better positioned to provide the care coordination and medical expertise that CMC require and, in some cases, may be the best option to be the medical home. 64,65 Some complex care clinics may not assume the responsibility of primary care, but rather coordinate and collocate the most essential specialty services related to the underlying conditions while comanaging with primary care. Three before-and-after studies of such services, 2 of which are comanagement consultative services and the third providing primary care, suggest overall financial savings through decreased emergency department and inpatient utilization, 66 -68 while acknowledging that payment models are insufficient to cover the costs of the services provided.…”