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Social Work Services Utilization by Children with Medical Complexity
Madeline Coquillette1, Joanne E Cox2, Sara Cheek3
1Division of General Pediatrics, Department of Medicine, Children's Hospital Primary Care Center, Boston Children's Hospital, 300 Longwood Avenue, Hunnewell Ground Floor, Boston, MA, 02115, USA. madeline.coquillette@childrens.harvard.edu.
Insights
Children with medical complexity (CMC) utilize significantly more social work services than other children. This highlights the need for enhanced family-centered care models in pediatric primary care settings.
Area of Science:
- Pediatric Healthcare
- Social Work Services
- Health Services Research
Background:
- Children with medical complexity (CMC) present unique challenges for families and healthcare systems.
- There is a growing need to understand resource utilization for CMC to develop effective support systems.
Purpose of the Study:
- To quantify and compare hospital-wide social work services utilization between CMC and non-medically-complex children (non-CMC).
- To inform the development of family-centered care models for vulnerable pediatric populations.
Main Methods:
- A retrospective analysis of social work department records from a tertiary children's hospital.
- Comparison of CMC (n=564) and age/sex-matched non-CMC (n=1128) over 16 months.
- Outcome measures included service utilization proportion and mean hours per patient.
Main Results:
- CMC showed significantly higher social work service utilization (60.3% vs. 18.9%) and hours per child (5.50 vs. 0.69).
- Medical complexity independently predicted greater odds of service use and higher service hours (odds ratio 6.23, 8.07 times more hours).
Conclusions:
- Children with medical complexity demonstrate substantially higher use of social work services within the medical setting.
- Findings underscore the necessity of integrating comprehensive social work support into proactive medical home models for CMC.
- Further research is warranted to identify specific drivers of social work service utilization in this population.
Objectives:
Children with medical complexity (CMC) are a growing population in pediatric primary care practices, and families caring for these children face increased medical, developmental, education and social needs. The objective of this study was to quantify hospital-wide social work services utilization by CMC compared to non-medically-complex children (non-CMC) to inform the development of family-centered care models that support these vulnerable patients and families.
Methods:
Social work department records from a tertiary children's hospital were used to compare CMC aged 0-17 (n = 564) with age- and sex-matched non-CMC (n = 1128) over a 16-month retrospective period. The main outcomes measures were the proportion of patients who used social work services and mean number of hours of services provided per patient, both by social work providers in the primary care setting and throughout the hospital.
Results:
A greater percentage of CMC used social work services than non-CMC (60.3 vs. 18.9%), and CMC used more hours per child (5.50 h/child vs. 0.69). In multivariate analysis, medical complexity was associated with 6.23-fold greater odds of using social work services (95% CI 4.94-7.85) and with 8.07 times more hours of services per child (95% CI 6.30-10.34), independent of primary health insurance, age, or sex.
Conclusion:
This study confirms that CMC use significantly more social work services in the medical setting. This must be considered when designing proactive medical home models to provide high quality family-centered care for this population, and further research is needed to elucidate the factors that drive this utilization.
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