How Avoidable are Hospitalizations for Children With Medical Complexity? Understanding Parent Perspectives

Complex Care Hospital Use and Postdischarge Coaching: A Randomized Controlled Trial

“…Using a structured approach over a 12-month period, we developed the PACT intervention by integrating findings from systematic literature review, 3 in-depth caregiver interviews, 16 and the RAND-UCLA Appropriateness Method with a national expert panel, 14 each focused on preventing the hospitalization of CMC. The Medical Home Program clinical and research teams collaborated in all aspects of intervention development, implementation, and testing.…”

Encounters From Device Complications Among Children With Medical Complexity

“…There were at least 2 important domains from our conceptual models (Supplemental Table 6) 14,30 unavailable in this analysis: health care system support for families and self-efficacy to manage medical devices. Subsequent prospective research should aim to incorporate the presence and quality of education and ongoing support available to CMC caregivers and whether devicecomplications can be reduced with specific educational or support interventions.…”

“…By focusing on reducing caregiver unmet needs for personal and community resources, consistent access to supplies and knowledgeable providers, and proactive crisis planning, complex care programs offer several potential mechanisms for reducing these visits. 7,14,30,37 As a future study, we plan to evaluate the change in device-complication visits after enrollment into our complex care program and compared with a propensity-matched CMC cohort.…”

“…Most research on CMC assisted by medical devices has explored caregiver experiences, 8,[12][13][14] overall use, 9,11 or single devices such as tracheostomy [15][16][17][18][19] or home oxygen therapy. 20,21 Reliable and valid indicators of device complication encounters are underdeveloped.…”

Emergency department visits for children with cerebral palsy: what triggers the call for help?

“…Children of higher medical complexity do have fewer admissions for ambulatory care sensitive conditions than other children, yet they still have avoidable admissions . Parents of children with medical complexity perceive hospitalizations to be unavoidable because of the inherently high medical fragility of their children . Tertiary care center‐based structured clinical programs for children with medical complexity are associated with decreased emergency department utilization, hospital days, and total costs, suggesting that accessible, coordinated, and goal‐directed care by familiar providers with ready access to tertiary care colleagues can reduce overutilization and the related costs of care.…”