Well-Child Visits of Medicaid-Insured Children with Medical Complexity

Shumskiy, Igor; Richardson, Troy; Brar, Sumeet; Hall, Matt; Cox, Joanne E.; Crofton, Charis; Peltz, Alon; Samuels‐Kalow, Margaret; Alpern, Elizabeth R.; Neuman, Mark I.; Berry, Jay G.

doi:10.1016/j.jpeds.2018.04.003

Cited by 21 publications

(18 citation statements)

References 53 publications

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“…The American Academy of Pediatrics generally recommends that children under 3 years of age receive more frequent preventive care visits throughout the year and children between 3 and 21 years of age receive an annual preventive care visit. 14 Our findings reveal that the large majority of US children with heart conditions may be following those guidelines, although older children with heart conditions may be slightly less likely than younger children with heart conditions to receive preventive care annually, similar to previous studies on children with parent-reported special healthcare needs 1,15 and children without chronic conditions. 15 It is unclear whether this difference is due to the routine vaccination schedule, which recommends more vaccinations at younger ages, 14 or competing priorities for older relative to younger children.…”

Section: Discussionsupporting

confidence: 78%

“…Only one study has examined preventive care among children with parent-reported special healthcare needs with heart conditions, 8 while others have examined preventive care among children with parent-reported special healthcare needs in general or children with medical complexities, which may include heart conditions. 1,15,19 These studies estimated receipt of preventive care in the last 12 months by 90% of children with parent-reported special healthcare needs with heart conditions, 8 80-91% of children with parent-reported special healthcare needs in general, 19 and 60-89% of Medicaid-covered children with medical complexities in New York. 15 Our study and these indicate that a large percentage of children receive preventive care in any given year.…”

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confidence: 99%

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Preventive care and medical homes among US children with heart conditions

et al. 2020

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Within a medical home, primary care providers can identify needs, provide services, and coordinate care for children with heart conditions. Using parent-reported data from the 2016–2017 National Survey of Children’s Health, we examined receipt of preventive care in the last 12 months and having a medical home (care that is accessible, continuous, comprehensive, family-centred, coordinated, compassionate, and culturally effective) among US children aged 0–17 years with and without heart conditions. Using the marginal predictions approach to multivariable logistic regression, we examined associations between presence of a heart condition and receipt of preventive care and having a medical home. Among children with heart conditions, we evaluated associations between sociodemographic and health characteristics and receipt of preventive care and having a medical home. Of the 66,971 children included, 2.2% had heart conditions. Receipt of preventive care was reported for more children with heart conditions (91.0%) than without (82.7%) (adjusted prevalence ratio = 1.09, 95% confidence interval: 1.05–1.13). Less than half of children with heart conditions (48.2%) and without (49.5%) had a medical home (adjusted prevalence ratio = 1.02, 95% confidence interval: 0.91–1.14). For children with heart conditions, preventive care was slightly more common among younger children and less common among those with family incomes 200–399% of the federal poverty level. Having a medical home was less common among younger children, non-Hispanic “other” race, and those with ≥2 other health conditions. Most children with heart conditions received preventive care, but less than half had a medical home, with disparities by age, socioeconomic status, race, and concurrent health conditions. These findings highlight opportunities to improve care for children with heart conditions.

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Section: Discussionsupporting

confidence: 78%

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confidence: 99%

Preventive care and medical homes among US children with heart conditions

et al. 2020

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“…However, a US study has shown that children with medical complexity often did not have their annual well child checks, but those who did had reduced hospital admissions. 26 There are similar results for adult patients, where higher continuity of care by GPs has been associated with fewer emergency department attendances 27 and lower mortality. 28 Implications for research and practice The 2012 Chief Medical Officer's report 11 recommended that CYP with long-term conditions should have a named GP who coordinates their care.…”

Section: Comparison With Existing Literaturementioning

confidence: 77%

GPs’ role in caring for children and young people with life-limiting conditions: a retrospective cohort study

et al. 2020

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BackgroundGPs are rarely actively involved in healthcare provision for children and young people (CYP) with life-limiting conditions (LLCs). This raises problems when these children develop minor illness or require management of other chronic diseases.AimTo investigate the association between GP attendance patterns and hospital urgent and emergency care use.Design and settingRetrospective cohort study using a primary care data source (Clinical Practice Research Datalink) in England. The cohort numbered 19 888.MethodCYP aged 0–25 years with an LLC were identified using Read codes (primary care) or International Classification of Diseases 10 th Revision (ICD-10) codes (secondary care). Emergency inpatient admissions and accident and emergency (A&E) attendances were separately analysed using multivariable, two-level random intercept negative binomial models with key variables of consistency and regularity of GP attendances.ResultsFace-to-face GP surgery consultations reduced, from a mean of 7.12 per person year in 2000 to 4.43 in 2015. Those consulting the GP less regularly had 15% (95% confidence interval [CI] = 10% to 20%) more emergency admissions and 5% more A&E visits (95% CI = 1% to 10%) than those with more regular consultations. CYP who had greater consistency of GP seen had 10% (95% CI = 6% to 14%) fewer A&E attendances but no significant difference in emergency inpatient admissions than those with lower consistency.ConclusionThere is an association between GP attendance patterns and use of urgent secondary care for CYP with LLCs, with less regular GP attendance associated with higher urgent secondary healthcare use. This is an important area for further investigation and warrants the attention of policymakers and GPs, as the number of CYP with LLCs living in the community rises.

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“…Until new standards of care emerge and are widely adopted by clinicians caring for these children, transitions from acute care settings to home, rehabilitation facilities, or other long‐term care environments will remain convoluted and potentially wrought with errors 27,42–46 . In particular, domains of clinical responsibility have presented new challenges to caring for CMC given many pediatric primary care providers do not feel equipped to manage care for these children and often default to and rely upon specialty clinicians for their ongoing care needs 47 .…”

Section: Resultsmentioning

confidence: 99%

Children with medical complexity: A concept analysis

et al. 2021

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Aim The aim of this paper is to conduct a concept analysis on the term, “children with medical complexity.” Background Children with medical complexity (CMC) describes pediatric patients with chronic, sustained acuity; however, there is a lack of consensus in the literature regarding its exact meaning, characteristics, and implications. Design This analysis relied upon the framework described by Walker and Avant. Data Source The CINAHL, MEDLINE, and PubMed databases were queried from April 2020 to December 2020 with an initial search of the literature for the keyword, “children with medical complexity” and other associated terms, such as “pediatric medical complexity” and “nursing care of children with medical complexity.” Review Methods This analysis will explore the concept of CMC and its significance, attributes, antecedents, and consequences. Results This investigation revealed that CMC are a growing population of pediatric patients who have one or more complex chronic conditions that affect multiple body systems, experience functional limitations, require extensive care coordination from multiple providers, and are dependent upon life‐sustaining medical technology. Conclusions The findings can serve as a foundation for future work advancing the understanding of the topic of CMC.

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Well-Child Visits of Medicaid-Insured Children with Medical Complexity

Cited by 21 publications

References 53 publications

Preventive care and medical homes among US children with heart conditions

Preventive care and medical homes among US children with heart conditions

GPs’ role in caring for children and young people with life-limiting conditions: a retrospective cohort study

Children with medical complexity: A concept analysis

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