Mobile Complex Care Plans to Enhance Parental Engagement for Children With Medical Complexity

Abstract

Care plans can reduce care fragmentation for children with medical complexity (CMC); however, implementation is challenging. Mobile health innovations could improve implementation. This mixed methods study’s objectives were to (1) evaluate feasibility of mobile complex care plans (MCCPs) for CMC enrolled in a complex care program and (2) study MCCPs’ impact on parent engagement, parent experience, and care coordination. MCCPs were individualized, updated quarterly, integrated within the electronic health record, and visible on parents’ mobile devices via an online portal. In 1 year (September 1, 2016, to August 31, 2017), 94% of eligible patients (n = 47) received 162 MCCPs. Seventy-four percent of parents (n = 35) reviewed MCCPs online. Forty-six percent of these parents (n = 16) sent a follow-up message, and the care team responded within 8 hours (median time = 7.2 hours). In interviews, parents identified MCCPs as an important reference and communication tool. MCCPs for CMC in a complex care program were feasible, facilitated parental engagement, and delivered timely communication.

Telemedicine Video Visits for Children with Medical Complexity in a Structured Clinical Complex Care Program

“…Children with medical complexity (CMC) defined by internally developed complexity criteria based on the Children with Special Healthcare Needs (CSHCN) Screener 14 ( Figure 1 ) were eligible for care by Duke Children’s Complex Care Service (CCS), a complex care program launched in 2014 to serve CMC with most of their specialty care at Duke. 15 Since its inception, 155 CMC have been enrolled for enhanced care by CCS. Patients are cared for by an interdisciplinary team consisting of 2 nurses, 1 nurse practitioner (NP), 1 social worker, with 2 program coordinators, with clinical supervision from 6 pediatric hospitalists who rotate concurrently to support the CCS team while rounding on the inpatient wards.…”

Increasing the Focus on Children's Complex and Integrated Care Needs: A Position Paper of the European Academy of Pediatrics

“…An integrated care approach was identified as necessary to support a person-centered approach to the care of children with complex care needs ( 4 , 5 ), while cross-sector, integrated and assertive care delivery was identified as necessary for safeguarding the well-being and development of children with complex care needs ( 6 ). Principles of integrated care were also frequently mentioned in the literature reviewed ( 7 – 11 ).…”

Health Care Use and Costs of Children, Adolescents, and Young Adults With Somatic Symptom and Related Disorders

“…26 , 35 Yet, unlike their peers with complex medical conditions, these children, adolescents, and young adults have not been subject to the same health system responsiveness for care navigation, coordination, and interventions. 35 , 36 , 37 , 38 , 39 Costs related to SSRDs are high in hospitalized adults in Italy, with mean annual per-patient costs of €47 540. 9 In both inpatients and outpatients in Holland, mean direct and indirect costs were estimated at €6815 per patient per year.…”