Point-of-Care Complexity Screening Algorithm to Identify Children With Medical Complexity

Abstract

OBJECTIVES: For pediatric complex care programs to target enhanced care coordination services to the highest-risk patients, it is critical to accurately identify children with medical complexity (CMC); however, no gold standard definition exists. The aim of this study is to describe a point-of-care screening algorithm to identify CMC with high health care use, a group that may benefit the most from improved care coordination. METHODS: From July 1, 2015, to June 30, 2016 (fiscal year 2016 [FY16]), a medical complexity screening algorithm was implemented by a pediatric complex care program at a single tertiary care center for hospitalized patients at the time of admission. Using the screening algorithm, we categorized inpatients into 1 of 3 groups: CMC, children with special health care needs (CSHCN), or previously healthy (PH) children. Inpatient resource use for FY16 and FY17 encounters was extracted for children screened in FY16. RESULTS: We categorized 2187 inpatients in FY16 into the 3 complexity groups (CMC = 77; CSHCN = 1437; PH children = 673). CMC had more complex chronic conditions (median = 6; interquartile range [IQR] 4–11) than CSHCN (median = 1; IQR 0–2) and PH children (median = 0; IQR 0–0). CMC had greater per-patient and per-encounter hospital use than CSHCN and PH children. CMC and children with ≥4 complex chronic conditions had comparable levels of resource use. CONCLUSIONS: By implementation of a point-of-care screening algorithm, we identified CMC with high health care use. By using this algorithm, it was feasible to identify hospitalized CMC that could benefit from care coordination by a pediatric complex care program.

Assessing the Impact of a Telemedicine Program on Caregivers of Children with Complex Chronic Conditions (Preprint)

“…As inclusion criteria, children must meet the definition of the medical complexity algorithm defined by the Seattle Children's Hospital Group and score at least 6,5 points on the PedCom Scale (20,21). They also had to be followed in the Complex Chronic Patient and Pediatric Palliative Care Unit of the hospital and had a high level of complexity, defined not only by the identification of the child as a complex chronic patient but also by the need of high consumption of resources: two or more hospital admissions; at least one admission to intensive care or six or more visits to the emergency department in the last twelve months) (22). Patients older than 18 years of age or those families not signing the informed consent where excluded.…”

Complexity of care in the emergency department: Shall we treat the whole person to prevent revisits?

“…Teniendo como centro al paciente y su complejidad, también se han consensuado diferentes modelos de análisis de los procesos asistenciales dentro de unidades hospitalarias 2 , la calidad de los servicios sanitarios 8 , el análisis de eventos adversos 9,10 , algoritmos de toma de decisión 11 y sistemas de alerta temprana 12,13 (early warning system) para reconocer de manera precoz al pa-ciente que, por su complejidad, necesita mayor rapidez y priorización de cuidados. La novedad que aporta el estudio de Urbina et al 14 , publicado en este número de EMERGENCIAS, es analizar la asociación entre la reconsulta en un servicio de urgencias y los factores de complejidad de los pacientes.…”