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[Children's medically complex diseases unit. A model required in all our hospitals]
Francisco José Climent Alcalá1, Marta García Fernández de Villalta1, Luis Escosa García1
1Unidad de Patología Compleja, Servicio de Pediatría, Hospital La Paz, Madrid, España.
Insights
Specialized units effectively manage medically complex children (MCC) with chronic conditions. These units provide essential care, reducing readmissions and improving outcomes for technology-dependent pediatric patients.
Area of Science:
- Pediatric Medicine
- Healthcare Management
- Chronic Disease Care
Background:
- Increased survival rates for children with severe illnesses have led to a rise in pediatric patients with chronic diseases and lifelong disabilities.
- A dedicated unit for medically complex children (MCC) was established in 2008 at Hospital La Paz to address this growing need.
Purpose of the Study:
- To characterize the operational activities and patient care provided by the MCC Unit.
- To analyze the outcomes and resource utilization within the specialized pediatric care setting.
Main Methods:
- Retrospective analysis of all discharge reports from the MCC Unit.
- Data collection period: January 2014 to July 2016.
- Inclusion of patient demographics, diagnoses, technology dependence, admission rates, length of stay, and mortality data.
Main Results:
- The MCC Unit, with 6 beds and an outpatient clinic, treated 1,027 patients (243 in 2014).
- Most patients (92.59%) had multiple chronic conditions, predominantly neurological (76.95%), gastrointestinal (63.78%), and respiratory (61.72%).
- High technology dependence was noted (69.54%), with significant needs for respiratory (53.49%) and nutritional support (35.80%). Annual admissions increased, with a 6-day median stay and over 100% occupancy. Readmission rates were 8.93%, and mortality was 9.05%, with infectious diseases being the leading cause of death.
Conclusions:
- Medically complex children require specialized care within dedicated units in tertiary or high-level hospitals.
- Specialized units are crucial for managing the complex needs of technology-dependent pediatric patients.
- Effective management in specialized units can potentially mitigate complications and improve patient trajectories.
Introduction:
The increase in survival of children with severe diseases has led to the rise of children with chronic diseases, sometimes with lifelong disabilities. In 2008, a unit for the specific care of medically complex children (MCC) was created in Hospital La Paz.
Objectives:
To describe the work and care activities of this Unit. Patients and methods An analysis was performed on all discharge reports of the Unit between January 2014 and July 2016.
Results:
The MCC Unit has 6 beds and daily outpatient clinic. A total of 1,027 patients have been treated since the creation of the unit, with 243 from 2014. The median age was 24.2 months (IQ: 10.21-84.25). The large majority (92.59%) have multiple diseases, the most frequent chronic conditions observed were neurological (76.95%), gastrointestinal (63.78%), and respiratory diseases (61.72%). More than two-thirds (69.54%) of MCC are dependent on technology, 53.49% on respiratory support, and 35.80% on nutritional support. Hospital admission rates have increased annually. There have been 403 admissions since 2014, of which 8.93% were re-admissions within 30 days of hospital discharge. The median stay during 2014-2016 was 6 days (IQ: 3-14). The occupancy rate has been above 100% for this period. Currently, 210 patients remain on follow-up (86.42%), and 11 children (4.53%) were discharged to their referral hospitals. The mortality rate is 9.05% (22 deaths). The main condition of these 22 patients was neurological (9 patients). Infectious diseases were the leading cause of death.
Conclusion:
MCC should be treated in specialized units in tertiary or high-level hospitals.
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