Presentations

Abstract

Introduction:

Children with Medical Complexity (CMC) are a subset of Children with Special Health Care Needs which have multiple chronic conditions, are seen by multiple medical specialists, are dependent on technology, and exhibit high health care utilization. Managing care for CMC is complicated and requires extensive coordination methods to ensure these children receive the care they need. This study aims to facilitate the implementation of a complex care clinic in a general academics practice by performing a landscape analysis of pediatric complex care programs throughout the nation.

Methods:

Semi-structured virtual interviews were conducted with representatives from complex care programs, with the option to correspond over email. Interviews consisted of six questions concerning the program's clinic structure, care model, CMC identification criteria, transition to adult care, and billing information.

Results:

Data from ten complex care programs was collected, two of which preferred to correspond via email. Seven programs reported functioning as a medical home providing primary care for CMC and three reported working as a consultation service for PCPs treating CMC patients. The most widely used criteria for identifying CMC were dependence on technology and the number of specialists seeing a child. Two programs reported not having any set identification criteria and work with any patient referred by their PCP. Various programs reported the existence of a transition program, but every program noted the difficulty of transitioning patients to adult care.

Conclusion/Discussion:

Several clinic representatives explained that their program had grown 'organically' out of the need for a care coordination program for CMC. Although some patterns can be seen between programs, the variation in care models and inclusion criteria can be attributed to this need- based implementation. Based on this analysis, the development of a program at general academic pediatrics (GAP) should be done by first assessing the patient population in need of complex care, and then determining which aspects of other programs would best care for its population. In addition, one model utilized their clinically integrated network model, similar to the one at GAP, to advocate for decreasing healthcare costs and as a way of funding the program for sustainability.