Hospitalist Care of the Medically Complex Child

Srivastava, Rajendu; Stone, Bryan L.; Murphy, Nancy

doi:10.1016/j.pcl.2005.03.007

Cited by 132 publications

(126 citation statements)

References 91 publications

Supporting

Mentioning

114

Contrasting

Unclassified

Order By: Relevance

“…Death is a rare occurrence in pediatric ward settings, and the seven studies conducted to date comparing pediatric hospitalist and traditional systems have been universally underpowered to detect differences in mortality. 9,[12][13][14][15][16][17][18] There is a need to better understand care processes as a first step in understanding and improving quality of care in hospitalist systems. 19 The Pediatric Research in Inpatient Settings (PRIS) Network was formed to improve the quality of care for hospitalized children through collaborative clinical research.…”

Section: Design and Measurementsmentioning

confidence: 99%

Variation in pediatric hospitalists' use of proven and unproven therapies: A study from the Pediatric Research in Inpatient Settings (PRIS) network

Landrigan

Conway

Stucky

et al. 2008

Journal of Hospital Medicine

View full text Add to dashboard Cite

BACKGROUND:Undesirable practice variation remains a major concern with the quality of the healthcare system. While care in pediatric hospitalist systems has been demonstrated to be efficient, neither the quality of care nor determinants of variation in pediatric hospitalist systems are well understood.OBJECTIVE:To measure variation in pediatric hospitalists' reported use of common inpatient therapies, and to test the hypothesis that variation in reported use of proven therapies is lower than variation in reported use of unproven therapies.DESIGN AND MEASUREMENTS:We conducted a survey of pediatric hospitalists in the US and Canada. Respondents reported their frequency of using 14 therapies in the management of common conditions. Each therapy was determined to be of proven or unproven effectiveness using published critical appraisals. Variation in reported use of proven and unproven therapies was compared.RESULTS:67% (213/320) of surveyed individuals participated. Little variability existed in reported use of albuterol and corticosteroids in asthma (4‐6% of respondents reported not often using them) and systemic dexamethasone in bronchiolitis (12% of respondents reported using it more than rarely). Moderate to high variation existed in reported use of all other therapies studied. Variation in reported use of proven therapies was significantly less than variation in reported use of unproven therapies (15.5 ± 12.5% vs. 44.6 ± 20.5%).CONCLUSIONS:Substantial variation exists in hospitalists' reported management of common pediatric conditions. Variation is significantly lower for strongly evidence‐based therapies. To decrease undesirable variation in care, a stronger evidence base for inpatient pediatric care must be built. Journal of Hospital Medicine 2008;3:292–298. © 2008 Society of Hospital Medicine.

show abstract

Section: Design and Measurementsmentioning

confidence: 99%

Variation in pediatric hospitalists' use of proven and unproven therapies: A study from the Pediatric Research in Inpatient Settings (PRIS) network

Landrigan

Conway

Stucky

et al. 2008

Journal of Hospital Medicine

View full text Add to dashboard Cite

show abstract

“…5,8,9 The prevalence of children with CCCs in the inpatient hospital setting has increased, 10,11 and their EOL care in this setting is highly technical. 12 Accordingly, the average cost of health care services for these children ranges from $62,000 to $110,000 annually. 13 Although existing literature provides knowledge about children with CCCs, a comprehensive profile of their demographic and health characteristics, health care utilization, and expenditures at EOL is lacking.…”

Section: Introductionmentioning

confidence: 99%

A Profile of Children with Complex Chronic Conditions at End of Life among Medicaid Beneficiaries: Implications for Health Care Reform

Lindley

Lyon

2013

Journal of Palliative Medicine

View full text Add to dashboard Cite

Background: As the United States braces for full implementation of health care reform, the eyes of the nation are on Medicaid. The large number of newly eligible Medicaid beneficiaries may challenge health care resources and ultimately impact quality of care. This is a special concern among current Medicaid beneficiaries such as children with complex chronic conditions (CCCs) who have significant health care needs, especially at end of life (EOL). Yet, a comprehensive profile of these children is lacking. Objective: To understand the demographic and health characteristics, health care utilization, and expenditures among Medicaid children with CCCs at EOL. Methods: Our study used a retrospective cohort design with data from the 2007 and 2008 California Medicaid data files. Descriptive statistics were used to profile children in the last year of life. Results: We found a diverse group of children who suffered with serious, multiple chronic conditions, and who accessed comprehensive, multidisciplinary care. Most children had neuromuscular conditions (54%), cardiovascular conditions (46%), and cancer (30%). A majority (56%) had multiple CCCs. Children with CCCs received comprehensive care including hospital inpatient (67%), primary (82%), ancillary (87%), and other acute care services (83%); however, few children utilized hospice and home health care services (26%). Significant age differences existed among the children. Conclusions: The current California Medicaid system appears to provide comprehensive care for children at EOL. The underutilization of hospice and home health services, however, represents an opportunity to improve the quality of EOL care while potentially reducing or remaining budget neutral.

show abstract

“…In the inpatient setting, this may be because the care coordination involves the highly rigorous tasks of not only managing medical issues, but also (1) coordinating and organizing care from subspecialists to avoid duplication of services, (2) sharing information between families and other members of the health care team, (3) c are planning with particular attention to minimizing errors, (4) discharge planning including ensuring safety and accessibility for technology-dependent patients, and (5) educating families. 13 A possible solution to address time-intensive care coordination needs for CMC include the formation of multidisciplinary teams that conduct family-centered rounds to allow all involved in the care of the complex child, including family, medical staff, and bedside nurses to be included in the decision-making. [17][18][19][20][21] Families are the pediatric patient's main source of support, and offer the health care team valuable information unique to their child which helps in decisionmaking and may positively affect health outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Seamless transitions are imperative for these patients, because their level of complexity places them at risk for errors in care. 13 Recent literature has addressed the importance of transitions in fragile populations; one study reported that elderly, frail patients are twice as likely to report problems after discharge when their PCP was not aware of the hospitalization 22 and another showed that patients without "timely" PCP follow-up were more likely to be readmitted. 23 More than half of the pediatric hospitalists who responded perceived the lack of PCP engagement in the care of CMC to be an important barrier.…”

Section: An Official Journal Of the American Academy Of Pediatricsmentioning

confidence: 99%

“…12 There is a paucity of literature regarding the optimal model of care for the hospitalized CMC, barriers to delivering care to CMC, or pediatric hospitalists' perspectives on the best way to deliver care to these patients. Srivastava et al 13 clearly describe that the care for hospitalized CMC should be family-centered, coordinated, aimed at minimizing harm, and focused on issues affecting the "whole child" such as nutrition and functional limitations. Historically, |…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Pediatric Hospitalists’ Perspectives on the Care of Children With Medical Complexity

Adame

Rocha

Louden

et al. 2011

Hospital Pediatrics

View full text Add to dashboard Cite

OBJECTIVE: The aims of this study were to identify pediatric hospitalists' perceived views of (1) barriers to delivering care to children with medical complexity (CMC) and (2) their preferred model of inpatient health care delivery for CMC. SUBJECTS:American Academy of Pediatrics Section on Hospital Medicine (AAP-SOHM) Listserv subscribers. METHODS:We conducted a cross-sectional survey of subscribers of the AAP-SOHM Listserv using the survey instrument SurveyMonkey®. Our survey was coadministered with a survey on pediatric hospitalist career satisfaction. RESULTS:The most signifi cant barriers to delivering care to CMC were (1) time constraints (89%), (2) inadequate postdischarge resources (75%), and (3) lack of evidence-based guidelines (64%). Although most pediatric hospitalists in an inpatient service currently care for both CMC and non-CMC patients (91%), only 25% perceive this to be the optimal service model for CMC. The majority of hospitalists (56%) believe that CMC are better served by either an inpatient service dedicated to CMC (30%) or comanaged with an inpatient consult service for CMC (26%). CONCLUSIONS:Identifying the perceived barriers to delivering care to CMC can assist pediatric hospitalists to design studies determining if care delivery is affected by these barriers. Most hospitalists care for CMC on the same service as uncomplicated patients, yet over half perceive that a different model of care delivery would better serve the needs of CMC.

show abstract

Hospitalist Care of the Medically Complex Child

Cited by 132 publications

References 91 publications

Variation in pediatric hospitalists' use of proven and unproven therapies: A study from the Pediatric Research in Inpatient Settings (PRIS) network

Variation in pediatric hospitalists' use of proven and unproven therapies: A study from the Pediatric Research in Inpatient Settings (PRIS) network

A Profile of Children with Complex Chronic Conditions at End of Life among Medicaid Beneficiaries: Implications for Health Care Reform

Pediatric Hospitalists’ Perspectives on the Care of Children With Medical Complexity

Contact Info

Product

Resources

About