Implementing a Care Coordination Strategy for Children with Medical Complexity in Ontario, Canada: A Process Evaluation

Quartarone, Samantha; Lin, Jia Lu Lilian; Orkin, Julia; Fayed, Nora; French, Simon; Major, Nathalie; Soscia, Joanna; Lim, Audrey; Diaz, Sanober; Moretti, Myla E; Cohen, Eyal

doi:10.5334/ijic.6073

Cited by 4 publications

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“…Health care utilization and quality of life may also be difficult to change because of the underlying medical complexity and fragility of the children enrolled. Further, the implementation of CCKO across 12 sites may have led to heterogeneity in the implementation of the CCKO model . Due to the pragmatic nature of the trial, there were delays for some patients in the intervention group being seen (the median date of the first appointment was 3 months postrandomization), which may explain why some differences between the groups may not have been apparent at 12 months.…”

Section: Discussionmentioning

confidence: 99%

“…The core components of CCKO included assignment of a nurse practitioner, partnering with a pediatrician to lead care; development and dissemination of a complex care plan; and care coordination across locations, the care continuum, and service systems . A description of CCKO has been published previously highlighting specific elements of care coordination and planning . The aim of this study was to compare the effectiveness of the CCKO intervention with usual care.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of Structured Care Coordination for Children With Medical Complexity

et al. 2023

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ImportanceChildren with medical complexity (CMC) have chronic conditions and high health needs and may experience fragmented care.ObjectiveTo compare the effectiveness of a structured complex care program, Complex Care for Kids Ontario (CCKO), with usual care.Design, Setting, and ParticipantsThis randomized clinical trial used a waitlist variation for randomizing patients from 12 complex care clinics in Ontario, Canada, over 2 years. The study was conducted from December 2016 to June 2021. Participants were identified based on complex care clinic referral and randomly allocated into an intervention group, seen at the next available clinic appointment, or a control group that was placed on a waitlist to receive the intervention after 12 months.InterventionAssignment of a nurse practitioner–pediatrician dyad partnering with families in a structured complex care clinic to provide intensive care coordination and comprehensive plans of care.Main Outcomes and MeasuresCo-primary outcomes, assessed at baseline and at 6, 12, and 24 months postrandomization, were service delivery indicators from the Family Experiences With Coordination of Care that scored (1) coordination of care among health care professionals, (2) coordination of care between health care professionals and families, and (3) utility of care planning tools. Secondary outcomes included child and parent health outcomes and child health care system utilization and cost.ResultsOf 144 participants randomized, 141 had complete health administrative data, and 139 had complete baseline surveys. The median (IQR) age of the participants was 29 months (9-102); 83 (60%) were male. At 12 months, scores for utility of care planning tools improved in the intervention group compared with the waitlist group (adjusted odds ratio, 9.3; 95% CI, 3.9-21.9; P &lt; .001), with no difference between groups for the other 2 co-primary outcomes. There were no group differences for secondary outcomes of child outcomes, parent outcomes, and health care system utilization and cost. At 24 months, when both groups were receiving the intervention, no primary outcome differences were observed. Total health care costs in the second year were lower for the intervention group (median, CAD$17 891; IQR, 6098-61 346; vs CAD$37 524; IQR, 9338-119 547 [US $13 415; IQR, 4572-45 998; vs US $28 136; IQR, 7002-89 637]; P = .01).Conclusions and RelevanceThe CCKO program improved the perceived utility of care planning tools but not other outcomes at 1 year. Extended evaluation periods may be helpful in assessing pediatric complex care interventions.Trial RegistrationClinicalTrials.gov Identifier: NCT02928757

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effectiveness of Structured Care Coordination for Children With Medical Complexity

et al. 2023

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“…In Europe, multidisciplinary teams (MDT) are involved in the care of TDC, however, team compositions vary depending on nations from the level of individual professions being in charge of a patient, hospital MDT, partially-mixed MDT, to fully-mixed MDT [8]. In the US [9] and in Canada [10] as well, structures of MDT vary depending on areas, states, or types of health insurance.…”

Section: Introductionmentioning

confidence: 99%

Problems and Possibilities of Technology-Dependent Children with Long-term Home Ventilation: 10 Years of Implementation of Home Medical Care in Japan

Maeda,

Tomomatsu,

Iikura

et al. 2023

Preprint

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Purpose Since the establishment of Japan’s publicly-supported pediatric home medical care (PHMC) system in 2012, the number of technology-dependent children (TDC) who are supported by PHMC, particularly with respiratory devices, keeps increasing. We aimed to study the problems of the care-burden of families who use this system in relation to TDC’s mobility and recovery process, with a focus on respiratory supports. Methods Questionnaire survey data were collected from 1,162 caregivers of TDC from 2018 to 2020. In each medical procedure, the correlation of TDC’s motor function level with care burden (Care Time (CT) & Self-rated Care Burden (SCB)) was analyzed by using correlation analysis. In 15 households caregivers’ activities were monitored to elucidate the problems of the care objectively. The follow-up study was conducted on a subpopulation whose medical records were accessible. Results Analysis of 418 cases showed that care-burden increased with improvements in the children’s motor ability in tracheostomy, or remained the same in other procedures. A follow-up study in 262 cases showed that these TDC with high mobility aged 1–8 had a high potential to be weaned from medical devices. Conclusion TDC who gain motor ability during the course of PHMC has more potential to be released from their respiratory devices and for better daily life. However, when they become mobile, social support is cut off despite the increase in care-burden for mobile TDC. It is important to maintain social support for TDC on the recovering mobile stage.

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“…In Europe, multidisciplinary teams (MDT) are involved in the care of TDC; however, team compositions vary depending on nations from the level of individual professions being in charge of a patient, hospital MDT, partially mixed MDT, to fully-mixed MDT [ 8 ]. In the USA [ 9 ] and in Canada [ 10 ] as well, structures of MDT vary depending on areas, states, or types of health insurance.…”

Section: Introductionmentioning

confidence: 99%

The care burden for technology-dependent children with long-term home ventilation increases along with the improvement of their motor functions

Maeda,

Tomomatsu,

Iikura

et al. 2023

Eur J Pediatr

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Since the establishment of Japan’s publicly supported pediatric home medical care (PHMC) system in 2012, the number of technology-dependent children (TDC) who are supported by PHMC has been increasing. We expected care to become easier as TDC mobility increased. However, many family caregivers complained of the opposite, that the burden of care increased as TDC’s mobility increased. Therefore, we aimed to study the problems of the care burden of families in relation to the improvement of mobility of TDC with a focus on respiratory support. We conducted a survey among caregivers of TDC in two parts: a first survey was done between 2018 and 2020, and a follow-up survey in 2023. In each medical procedure, the correlation of TDC’s motor function level with care burden was analyzed by using correlation analysis. In 15 households, caregivers’ activities were monitored to elucidate the problems of the care objectively. The second survey was conducted in February 2023 in TDC whose medical records were available. Analysis of 418 cases showed that care-burden increased with improvements in the children’s motor ability in tracheostomy, or remained the same in other procedures. A follow-up study in 262/418 cases of this group showed that part of these TDC with high mobility aged 1–8, after passing through the mobile phase with increased burden of care, had a high potential to be weaned from medical devices. Conclusion: For TDC who acquire motor skills during PHMC, the burden of care for caregivers either increases or remains the same. It is important to maintain social support for TDC on the recovering mobile stage. What is Known:• There was no clear information on the care burden when TDC become mobile. What is New:• We did a qualitative study to show that the care burden increases when TDC become mobile.• In addition, mobike TDC showed a high potential for recovery.

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Implementing a Care Coordination Strategy for Children with Medical Complexity in Ontario, Canada: A Process Evaluation

Cited by 4 publications

References 37 publications

Effectiveness of Structured Care Coordination for Children With Medical Complexity

Effectiveness of Structured Care Coordination for Children With Medical Complexity

Problems and Possibilities of Technology-Dependent Children with Long-term Home Ventilation: 10 Years of Implementation of Home Medical Care in Japan

The care burden for technology-dependent children with long-term home ventilation increases along with the improvement of their motor functions

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