Strategies to Reduce Hospitalizations of Children With Medical Complexity Through Complex Care: Expert Perspectives

Coller, Ryan J.; Nelson, Bergen B.; Klitzner, Thomas S.; Saenz, Adrianna A.; Shekelle, Paul G; Lerner, Carlos F.

doi:10.1016/j.acap.2017.01.006

Cited by 40 publications

(40 citation statements)

References 29 publications

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“…Although reducing hospitalizations is a goal of pediatric complex care programs 7, 24, 25 (and 1 previous RCT PEDIATRICS Volume 142, number 2, August 2018 5 The components of PACT were constructed from key drivers of CMC-hospital use 3,14 and informed by experience from other populations. CTI has a well-established record for preventing adult hospitalizations as far as 3 months after discharge.…”

Section: Discussionmentioning

confidence: 99%

“…We previously developed a key driver framework for reducing hospitalizations for CMC. 14 A caregiver coaching model (ie, Plans for Action and Care Transitions [PACT]) was conceived to prevent hospitalizations for CMC by influencing the following 2 key drivers: (1) early recognition of critical symptoms and execution of crisis plans and (2) seamless, comprehensive hospital transitions. 14 Our objective was to test in an RCT the effectiveness of PACT to reduce hospitalizations for CMC within a complex care medical home.…”

Section: What This Study Addsmentioning

confidence: 99%

“…Using a structured approach over a 12-month period, we developed the PACT intervention by integrating findings from systematic literature review, 3 in-depth caregiver interviews, 16 and the RAND-UCLA Appropriateness Method with a national expert panel, 14 each focused on preventing the hospitalization of CMC. The Medical Home Program clinical and research teams collaborated in all aspects of intervention development, implementation, and testing.…”

Section: Intervention: Pactmentioning

confidence: 99%

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Complex Care Hospital Use and Postdischarge Coaching: A Randomized Controlled Trial

Coller

Klitzner²,

Lerner³

et al. 2018

Pediatrics

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Section: Discussionmentioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

Section: Intervention: Pactmentioning

confidence: 99%

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Complex Care Hospital Use and Postdischarge Coaching: A Randomized Controlled Trial

Coller

Klitzner²,

Lerner³

et al. 2018

Pediatrics

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“…There were at least 2 important domains from our conceptual models (Supplemental Table 6) 14,30 unavailable in this analysis: health care system support for families and self-efficacy to manage medical devices. Subsequent prospective research should aim to incorporate the presence and quality of education and ongoing support available to CMC caregivers and whether devicecomplications can be reduced with specific educational or support interventions.…”

Section: Discussionmentioning

confidence: 99%

“…By focusing on reducing caregiver unmet needs for personal and community resources, consistent access to supplies and knowledgeable providers, and proactive crisis planning, complex care programs offer several potential mechanisms for reducing these visits. 7,14,30,37 As a future study, we plan to evaluate the change in device-complication visits after enrollment into our complex care program and compared with a propensity-matched CMC cohort.…”

Section: Discussionmentioning

confidence: 99%

Encounters From Device Complications Among Children With Medical Complexity

Nackers

Ehlenbach

Kelly

et al. 2019

Hospital Pediatrics

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A B S T R A C TOBJECTIVES: Children with medical complexity (CMC) are commonly assisted by medical devices to support essential body functions, although complications may lead to preventable emergency department (ED) and hospital use. Our objective was to identify predictors of device-complicated ED visits and hospitalizations.METHODS: This single-center retrospective cohort study included patients referred to a Pediatric Complex Care Program between April 1, 2014, and April 30, 2016, assisted by at least 1 medical device. Hospitalizations and ED visits in the year before enrollment were rated for likelihood for being due to device complications. Interrater reliability among 3 independent reviewers was assessed. Bivariate followed by multivariate logistic regression clustered by patient helped us identify associations between demographic, clinical, and device characteristics associated with device-complicated ED or hospital encounters. RESULTS:Interrater reliability was high (k 5 0.92). Among 98 CMC, device-complicated encounters represented 17% of 258 hospitalizations and 31% of 228 ED visits. Complications of 3 devices (central venous catheters, enteral tubes, and tracheostomy tubes) accounted for 13% of overall hospitalizations and 28% of overall ED visits. Central venous catheter presence (adjusted odds ratio [aOR] 3.2 [95% confidence interval (CI) 1.1-9.5]) was associated with device-complicated ED visits. Gastrojejunostomy/jejunostomy tube presence (aOR 3.3 [95% CI 1.5-7.5]) or tracheostomies with (aOR 8.1 [95% CI 2.3-28.5]) or without (aOR 4.5 [95% CI 1.7-7.5]) ventilator use was associated with device-complicated hospitalizations. Clinical variables were poor predictors of device-complicated encounters.CONCLUSIONS: Device-complicated ED visits and hospitalizations comprised a substantial proportion of total hospital and ED use. Developing interventions to prevent device complications may be a promising strategy to reduce overall CMC use.

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Identifying and Improving the Active Ingredients in Pediatric Complex Care

Feudtner

Hogan

2021

JAMA Pediatr

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Strategies to Reduce Hospitalizations of Children With Medical Complexity Through Complex Care: Expert Perspectives

Cited by 40 publications

References 29 publications

Complex Care Hospital Use and Postdischarge Coaching: A Randomized Controlled Trial

Complex Care Hospital Use and Postdischarge Coaching: A Randomized Controlled Trial

Encounters From Device Complications Among Children With Medical Complexity

Identifying and Improving the Active Ingredients in Pediatric Complex Care

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