Preventing or accelerating emergency care for children with complex healthcare needs

Sutton, David; Stanley, Paul; Babl, Franz E; Phillips, Fiona

doi:10.1136/adc.2007.117960

Cited by 37 publications

(37 citation statements)

References 18 publications

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“…CC models in community and health care settings merit further investigation given the supportive findings from this study. 23 The CC groups identified in these analyses represent unique experiences of families with CSHCN, including those 24,25 In 1 study, a majority of CSHCN reported receiving family-centered care.…”

Section: Discussionmentioning

confidence: 96%

Care Coordination for CSHCN: Associations With Family-Provider Relations and Family/Child Outcomes

et al. 2009

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OBJECTIVE: To examine the association between receiving adequate care coordination (CC) with family-provider relations and family/child outcomes. METHODS:We analyzed data from the 2005-2006 National Survey of Children With Special Health Care Needs. Eligible subjects were the 88% of families asked about experience with CC, service use, and communication. Respondents also reported on demographic characteristics, health status, family-provider relations, and family/child outcomes. Weighted, multivariate logistic regression models were constructed to assess independent associations of adequate CC with outcomes. RESULTS:Among families with children with special health care needs asked about CC, 68.2% reported receiving some type of CC help. Of these, 59.2% reported receiving adequate CC help, and 40.8% reported inadequate CC. Families that reported adequate compared with inadequate CC had increased odds of receiving family-centered care, experiencing partnerships with professionals, and satisfaction with services. They had decreased odds of having problems with referrals for specialty care, missing Ͼ6 school days because of illness (previous year), and visiting the emergency department more than twice in the previous 12 months (P Ͻ .001). Those who reported adequate compared with inadequate CC had decreased odds of the following: more than $500/y of out-of-pocket expenses, family financial burden, spending more than 4 hours/week coordinating care, and stopping/reducing work hours. CONCLUSIONS:Parental report of adequate CC was associated with favorable family-provider relations and family/child outcomes. Additional efforts are needed to discern which aspects of CC are most beneficial and for which subgroups of children with special health care needs. Pediatrics 2009;124:S428-S434

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Section: Discussionmentioning

confidence: 96%

Care Coordination for CSHCN: Associations With Family-Provider Relations and Family/Child Outcomes

et al. 2009

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“…In this issue of Archives of Diseases of Childhood, Sutton and colleagues17 describe an emergency medicine extension programme intended to attenuate the use of emergency-department (ED) services by CSHCN while improving and expediting the care delivered. I offer kudos to the authors and their staff who provided care as part of the Accelerated Care through Emergency (ACE) Program.…”

mentioning

confidence: 99%

“…Sutton and colleagues17 established content validity for their programme through an advisory group with representation from parents, emergency staff, subspecialty medical providers and representatives from their institution with responsibility for home and community care. This led to development of a 24 hours per day, 7 days a week medical telephone service for CSHCN led by nurse coordinators with physician back-up.…”

mentioning

confidence: 99%

Specialty services for children with special health care needs: supplement not supplant the medical home

Graham

2008

Archives of Disease in Childhood

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“…Previous studies have found increased rates of admission from the PED for children with chronic conditions compared with children without chronic conditions, ranging from 28% to 38% vs 11% to 23% to the hospital and 1% vs 0.03% to the PICU. 15,19,31,32 This is the first study to use a tool to stratify children with chronic conditions by medical complexity and describe associated PED use and disposition. Although our findings about increased utilization with increased medical complexity are unique, they are not surprising.…”

Section: Discussionmentioning

confidence: 99%

Medical Complexity and Pediatric Emergency Department and Inpatient Utilization

2013

PEDIATRICS

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WHAT'S KNOWN ON THIS SUBJECT: Children with chronic conditions use the pediatric emergency department (PED) more frequently than children without chronic conditions. To date, no one has examined how medical complexity relates to PED use and disposition.WHAT THIS STUDY ADDS: Varying degrees of medical complexity among children with chronic conditions are associated with increased PED length of stay, inpatient admission, and PED visit frequency. Clinical Risk Group software is able to identify disproportionate users of PED and hospital resources. abstract OBJECTIVES: To characterize the use of and disposition from a tertiary pediatric emergency department (PED) by children with chronic conditions with varying degrees of medical complexity. METHODS:We conducted a retrospective cohort study using a dataset of all registered PED patient visits at Seattle Children' s Hospital from January 1, 2008, through December 31, 2009. Children' s medical complexity was classified by using a validated algorithm (Clinical Risk Group software) into nonchronic and chronic conditions: episodic chronic, lifelong chronic, progressive chronic, and malignancy. Outcomes included PED length of stay (LOS) and disposition. Logistic regression generated age-adjusted odds ratios (AOR) of admission with 95% confidence intervals (CIs).RESULTS: PED visits totaled 77 748; 20% (15 433) of which were for children with chronic conditions. Compared with visits for children without chronic conditions, those for children with chronic conditions had increased PED LOS (on average, 79 minutes longer; 95% CI 77-81; P , .0001) and hospital (51% vs 10%) and PICU (3.2% vs 0.1%) admission rates (AOR 10.3, 95% CI 9.9-10.7 to hospital and AOR 25.0, 95% CI 17.0-36.0 to PICU). Admission rates and PED LOS increased with increasing medical complexity. CONCLUSIONS:Children with chronic conditions comprise a significant portion of annual PED visits in a tertiary pediatric center; medical complexity is associated with increased PED LOS and hospital or PICU admission. Clinical Risk Group may have utility in identifying high utilizers of PED resources and help support the development of interventions to facilitate optimal PED management, such as pre-arrival identification and individual emergency care plans. Pediatrics 2013;131:e559-e565

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Preventing or accelerating emergency care for children with complex healthcare needs

Cited by 37 publications

References 18 publications

Care Coordination for CSHCN: Associations With Family-Provider Relations and Family/Child Outcomes

Care Coordination for CSHCN: Associations With Family-Provider Relations and Family/Child Outcomes

Specialty services for children with special health care needs: supplement not supplant the medical home

Medical Complexity and Pediatric Emergency Department and Inpatient Utilization

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