PDF(Pubmed)
Abstract：
BACKGROUND: Children with medical complexity (CMC) comprise < 1% of the pediatric population, but account for nearly one-third of healthcare expenditures. Further, while CMC account for up to 80% of pediatric inpatient hospital costs, only 2% of Medicaid spending is attributed to home healthcare. As a result, the current health system heavily relies on family caregivers to fill existing care gaps. This study aimed to: (1) examine factors associated with hospital admissions among CMC and (2) contextualize the potential for home nursing care to improve outcomes among CMC and their families in South Carolina (SC).
METHODS: This mixed-methods study was conducted among CMC, their family caregivers, and physicians in SC. Electronic health records data from a primary care clinic within a large health system (7/1/2022-6/30/2023) was analyzed. Logistic regression examined factors associated with hospitalizations among CMC. In-depth interviews (N = 15) were conducted among physicians and caregivers of CMC statewide. Patient-level quantitative data is triangulated with conceptual findings from interviews.
RESULTS: Overall, 39.87% of CMC experienced ≥ 1 hospitalization in the past 12 months. CMC with higher hospitalization risk were dependent on respiratory or neurological/neuromuscular medical devices, not non-Hispanic White, and demonstrated higher healthcare utilization. Interview findings contextualized efforts to reduce hospitalizations, and suggested adaptations related to capacity and willingness to provide complex care for CMC and their families.
CONCLUSIONS: Findings may inform multi-level solutions for accessible, high-quality home nursing care among CMC and their families. Providers may learn from caregivers\' insight to emphasize family-centered care practices, acknowledging time and financial constraints while optimizing the quality of medical care provided in the home.
METHODS: This mixed-methods study was conducted among CMC, their family caregivers, and physicians in SC. Electronic health records data from a primary care clinic within a large health system (7/1/2022-6/30/2023) was analyzed. Logistic regression examined factors associated with hospitalizations among CMC. In-depth interviews (N = 15) were conducted among physicians and caregivers of CMC statewide. Patient-level quantitative data is triangulated with conceptual findings from interviews.
RESULTS: Overall, 39.87% of CMC experienced ≥ 1 hospitalization in the past 12 months. CMC with higher hospitalization risk were dependent on respiratory or neurological/neuromuscular medical devices, not non-Hispanic White, and demonstrated higher healthcare utilization. Interview findings contextualized efforts to reduce hospitalizations, and suggested adaptations related to capacity and willingness to provide complex care for CMC and their families.
CONCLUSIONS: Findings may inform multi-level solutions for accessible, high-quality home nursing care among CMC and their families. Providers may learn from caregivers\' insight to emphasize family-centered care practices, acknowledging time and financial constraints while optimizing the quality of medical care provided in the home.
摘要：
背景：医学复杂性（CMC）儿童占儿科人口的<1％，但占医疗支出的近三分之一。Further,虽然CMC占儿科住院费用的80%，只有2%的医疗补助支出用于家庭医疗保健。因此,当前的卫生系统严重依赖家庭护理人员来填补现有的护理空白。这项研究旨在：（1）检查与CMC入院相关的因素，以及（2）将家庭护理的潜力与南卡罗来纳州（SC）的CMC及其家人改善预后的可能性联系起来。
方法：这项混合方法研究是在CMC中进行的，他们的家庭照顾者，和SC的医生。分析了大型卫生系统（7/1/2022-6/30/2023）中初级保健诊所的电子健康记录数据。Logistic回归分析了CMC患者住院相关因素。在全州范围内对CMC的医生和护理人员进行了深入访谈（N=15）。患者水平的定量数据与访谈中的概念发现进行三角剖分。
结果：总体而言，39.87%的CMC在过去12个月内经历了≥1次住院。住院风险较高的CMC依赖于呼吸或神经/神经肌肉医疗设备，不是非西班牙裔白人,并显示出更高的医疗保健利用率。采访结果与减少住院的努力相关，并建议与为CMC及其家人提供复杂护理的能力和意愿相关的适应措施。
结论：调查结果可能会为可访问，在CMC及其家庭中提供高质量的家庭护理。提供者可以向护理人员学习，强调以家庭为中心的护理实践，承认时间和财政限制，同时优化家庭提供的医疗质量。
方法：这项混合方法研究是在CMC中进行的，他们的家庭照顾者，和SC的医生。分析了大型卫生系统（7/1/2022-6/30/2023）中初级保健诊所的电子健康记录数据。Logistic回归分析了CMC患者住院相关因素。在全州范围内对CMC的医生和护理人员进行了深入访谈（N=15）。患者水平的定量数据与访谈中的概念发现进行三角剖分。
结果：总体而言，39.87%的CMC在过去12个月内经历了≥1次住院。住院风险较高的CMC依赖于呼吸或神经/神经肌肉医疗设备，不是非西班牙裔白人,并显示出更高的医疗保健利用率。采访结果与减少住院的努力相关，并建议与为CMC及其家人提供复杂护理的能力和意愿相关的适应措施。
结论：调查结果可能会为可访问，在CMC及其家庭中提供高质量的家庭护理。提供者可以向护理人员学习，强调以家庭为中心的护理实践，承认时间和财政限制，同时优化家庭提供的医疗质量。
