Population child health: understanding and addressing complex health needs

Abstract

Advances in paediatric care mean that more children with complex medical problems (heart disease, neurodevelopmental problems and so on) are surviving their early years. This has important implications for the design and delivery of healthcare given their extensive multidisciplinary requirements and susceptibility to poor outcomes when not optimally managed. Importantly, their medical needs must also be understood and addressed within the context of the child and family’s life circumstances. There is growing recognition that many other factors contribute to a child’s complex health needs (CHNs), for example, family problems, fragmentation of health and care provision, psychological difficulties or social issues.To facilitate proactive care for these patients, we must develop accurate ways to identify them. Whole Systems Integrated Care—an online platform that integrates routinely collected data from primary and secondary care—offers an example of how to do this. An algorithm applied to this data identifies children with CHNs from the entire patient population. When tested in a large inner-city GP practice, this analysis shows good concordance with clinical opinion and identifies complex children in the population to a much higher proportion than expected. Ongoing refinement of these data-driven processes will allow accurate quantification and identification of need in local populations, thus aiding the development of tailored services.

Patterns of healthcare utilisation in children and young people: a retrospective cohort study using routinely collected healthcare data in Northwest London

“…16 Comorbidities were selected from among 41 LTCs defined in Discover database. A subset of 17 of these chronic conditions identified in previous literature as relevant to children was included 17 (online supplemental table S1), supplemented by additional SNOMED code sets for relevant conditions not included in Discover database (online supplemental table S2) 18 identified from the entirety of the patient primary care record. Secondary care diagnostic codes were not included in order not to bias number of conditions in Open access favour of those presenting to secondary care, although they may be coded in the primary care record.…”

“…20 21 Models with low D-B scores and high C-H scores were examined further: (a) confusion matrices were constructed to compare cluster assignment in the model with k clusters against the model with k+1 clusters and (b) mean values for each utilisation variable were calculated for each cluster in each model. Further details of the clustering approach are given in online supplemental file 1 (see pages [5][6][7][8][9][10][11][12][13][14][15][16][17].…”

Final warning on the need for integrated care systems in acute paediatrics

“…Linked, and better quality, data sets will provide better information to take into account the wider determinants of physical AND mental health, across the life course, from the maternal-newborn continuum, through to young people transitioning to adult life. 6 Children and young people with longterm conditions need confidence and resilience in self management; healthcare delivered by peer support (including group consultations 7 ) and health promotion by webinar (eg, to address fears about immunisation) could harness support and improve understanding of how best to use healthcare resources. However, it will be important to demonstrate that services built around pooled resources rather than competitive tendering can indeed reduce children and young person's use of emergency care.…”

Categorising high-cost high-need children and young people

“…Advances in technology and care mean that children with complex needs are surviving for longer than they would have previously resulting in a growing cohort of children with complex needs who require prolonged intensive treatment. 1 Previous research demonstrates that in adults the top 5% of patients by cost account for over 50% of total costs in England, with the majority of this being inpatient care costs. 2 In other countries, this varies between 40% and 60%.…”