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

Abstract

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.

Hospital Readmission in Children With Complex Chronic Conditions Discharged From Subacute Care

“…These issues can make acute care hospital discharge to home challenging and contribute to increased readmission rates. 2,12,19,20 Thus, some children with CCC are transitioned to subacute pediatric specialty hospitals for transitional medical care as well as focused discharge preparation and teaching. However, we are not aware of any studies to date specifi cally examining readmission rates or risk factors for patients discharged from subacute care facilities.…”

Assessing Nursing Care Needs of Children With Complex Medical Conditions: The Nursing-Kids Intensity of Care Survey (N-KICS)

“…The number of children with complex medical conditions (CMC) has increased substantially over the past decade resulting in significant utilization of resources in acute inpatient and tertiary care centers (Adame, Rocha, Louden, & Agrawal, 2011; Simon et al, 2010; Cohen et al, 2012; Jurgens et al, 2014). Although many of these children are cared for at home (Elias et al, 2012), it is estimated that there 100 pediatric long term care (LTC) facilities for children with CMC in the U.S. (Larson, Cohen, Murray, & Saiman, 2014).…”

Children with medical complexity: A concept analysis

“…Until new standards of care emerge and are widely adopted by clinicians caring for these children, transitions from acute care settings to home, rehabilitation facilities, or other long‐term care environments will remain convoluted and potentially wrought with errors 27,42–46 . In particular, domains of clinical responsibility have presented new challenges to caring for CMC given many pediatric primary care providers do not feel equipped to manage care for these children and often default to and rely upon specialty clinicians for their ongoing care needs 47 . This is further exacerbated by the increasing number of CMC living into young adulthood, with many pediatric clinicians still taking the lead in caring for CMC who are no longer children 17 .…”