Significant reductions in tertiary hospital encounters and less travel for families after implementation of Paediatric Care Coordination in Australia

Abstract

BackgroundOver a third of Australian children have long-term health conditions, often involving multiple organ systems and resulting in complex health care needs. Our healthcare system struggles to meet their needs because of sectoral fragmentation and episodic models of care. Children with medical complexity (CMC) currently rely on tertiary paediatric hospitals for most of their healthcare, but this is not sustainable. We evaluated the impacts of Care Coordination on tertiary hospital service use and family outcomes.MethodsA pre- and post-implementation cohort evaluation of the Care Coordination service at a tertiary paediatric hospital network, was undertaken. From July 2015 CMC enrolled in the service had access to a Care Coordinator, shared-care plans, linkage with local general practitioners (GPs), and access to a 24-h Hotline from August 2016. CMC were those with ≥4 emergency department (ED) presentations, hospital stays of ≥14 days, or ≥ 10 outpatient appointments in 12 months. Medically fragile infants at risk of frequent future hospital utilisation, and children with medical problems complicated by difficult family psychosocial circumstances were also included. Care Coordinators collected outcomes for each enrolled child. Administrative data on hospital encounters 6 months pre- and post-enrolment were analysed for children aged > 6 months.ResultsAn estimated 557 hospital encounters, were prevented in the 6 months after enrolment, for 534 children aged > 6 months. ED presentations decreased by 40% (Chi2 = 37.95; P < 0.0001) and day-only admissions by 42% (Chi2 = 7.54; P < 0.01). Overnight admissions decreased by 9% but this was not significant. An estimated Au$4.9 million was saved over 2 years due to prevented hospital encounters. Shared-care plans were developed for 83.5%. Of 84 children who had no regular GP, 58 (69%) were linked with one. Fifty-five (10%) of families were linked to the 24-h Hotline to enable remote access to support and advice. Over 50,000 km of family travel and 370 school absences was prevented.ConclusionsThe Care Coordination service has clear benefits for the tertiary paediatric hospital network and for families. Ongoing evaluation is essential for continuous improvement and to support adjustments to the model according to the local context.

Prevalence, hospital admissions and costs of child chronic conditions: A population‐based study

“…Care co-ordination involving links with local general practitioners and access to a 24-h hotline has been shown to reduce subsequent encounters with tertiary hospitals, save on travel and reduce school absence. 28 Our findings of lower prevalence of admissions overall, and by category, among children from the most disadvantaged areas and those living in regional and remote areas may be explained by 24.0 †At first admission with chronic condition identified. ‡ Socio-economic disadvantage measured using geographic-based Index of Relative Socioeconomic Disadvantage, determined from postcode of residence.…”

“…Managed care plans may also provide a strategy to reduce admissions for children with such conditions. Care co‐ordination involving links with local general practitioners and access to a 24‐h hotline has been shown to reduce subsequent encounters with tertiary hospitals, save on travel and reduce school absence 28 …”

The challenges of caring for children who require complex medical care at home: ‘The go between for everyone is the parent and as the parent that’s an awful lot of responsibility’

“…There is a clear psychological impact on the whole family which needs to be core to the preparation and support parents receive. 25,30 In Canada and the United States, models of care for children with medical complexity are being tested in which care coordination is provided. 31 In the UK, community paediatricians and palliative care often help with co-ordination of care and the charity Well Child funds nurses who help with co-ordinating care, day-today emotional and practical support and also help train parents and carers, but these services need expanding.…”

Integrated Care Models and Child Health: A Meta-analysis

“…Our findings on ED attendance contrast with recent observational studies that have shown up to a 40% decrease in ED presentations for children with medical complexity. 53 This review highlights important concerns about the design and evaluation of children's integrated care. Information regarding the design of integrated interventions in the articles included in this review is limited because no studies presented or described the use of logic models to inform complex intervention development, which have been shown to improve intervention efficiency 54,55…”