A new publication sponsored by the national Children's Hospital Association shines a spotlight on a growing sub-population of children – Children with Medical Complexity (CMC) – and calls for health system redesign to provide better care for them.
Although there is no standard definition of this population, these children usually have chronic, severe health conditions and substantial health service needs; have major functional limitations; and are significant users of health care resources.
The study analyzes the extent and costs of health services use by CMC, noting that though they probably represent less than 1% of the child population, they account for more than a third of pediatric health care costs. The authors also examine gaps in how care is managed for CMC, and identify opportunities for improvement.
Care for these children usually is fragmented, uncoordinated, and crisis-driven with a tendency to over-medicalize the child and to under-support the child’s family caregivers, the study notes. The authors suggest that a better model of care would be one that:
- Provides urgent care in the outpatient setting to treat acute health problems
- Contains at least one outpatient provider who comprehensively addresses acute and chronic medical, functional and psychosocial needs
- Coordinates decision making among all participating health care providers
- Develops effective, proactive plans of care to maximize the child’s well-being and proactively anticipates health problems that are likely to occur
An improved system would address the fact that this type of services currently does not receive reimbursement, the authors say.
Among those helping to conceptualize and write the report was David A. Bergman, MD, associate professor of pediatrics at the Stanford University School of Medicine and director of a clinic devoted to CMC at Lucile Packard Children’s Hospital.
For more information about the study, contact Donna Shelton, 703-684-1355.