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Integrated children's clinic care (ICCC) versus a self-directed care pathway for children with a chronic health
Thuy Thanh Frakking1,2, John Waugh3,4, Hsien-Jin Teoh5
1Research Development Unit, Caboolture Hospital, Queensland Health, McKean St, Caboolture, QLD, 4510, Australia. thuy.frakking@health.qld.gov.au.
Insights
Integrated children's care clinics improve health outcomes for children with chronic conditions by coordinating care. This approach reduces wait times and improves quality of life compared to self-directed care.
Area of Science:
- Pediatric Health
- Health Services Research
- Chronic Disease Management
Background:
- Children with chronic conditions require coordinated care for optimal health outcomes.
- Increased demand on Australian ambulatory care leads to long waitlists, risking poorer child health and social outcomes.
- Traditional care models are costly and burdensome; community-based integrated care is proposed as a solution.
Purpose of the Study:
- To determine if an integrated children's care clinic (ICCC) improves health and economic outcomes compared to a self-directed care pathway.
- To evaluate the effectiveness of a community-based service-integration approach for managing pediatric chronic conditions.
Main Methods:
- An open, unblinded, multi-centre randomized controlled trial involving 112 children (0-16 years) in two Australian public hospitals.
- Children were randomized to either an integrated children's care clinic (ICCC) or a self-directed care pathway.
- Data collected via interviews at 1 week, and 3, 6, and 12 months, using measures like the Pediatric Quality of Life (PedQOL) questionnaire and Child Behaviour Checklist (CBCL).
Main Results:
- Primary outcomes include Pediatric Quality of Life (PedQOL), Subjective Units of Distress Scale, Child Behaviour Checklist (CBCL), and Rotter's Locus of Control Scale.
- Secondary outcomes assess medical appointments, school days missed, and services accessed.
- The study aims to compare health and economic outcomes between the ICCC and self-directed care pathways.
Conclusions:
- Integrated care pathways for children with chronic conditions offer potential for reduced waitlist times and improved access to health services.
- This study provides crucial clinical and health economics data on integrated care for pediatric chronic conditions.
- Findings will inform care coordination frameworks, particularly with the National Disability Insurance Scheme (NDIS) implementation in Australia.
Background:
Children with chronic health conditions have better health-related outcomes when their care is managed in a personalised and coordinated way. However, increased demand on Australian ambulatory care hospital services has led to longer waitlist times to access specialists and appropriate intervention services; placing vulnerable children at increased risk of poorer short-term (e.g. social difficulties) and long-term (e.g. convictions) health and social outcomes. Traditional approaches to increasing frequency and service of delivery are expensive and can have minimal impact on caregiver burden. A community based service-integration approach, rather than self-directed care is proposed as increased service linkages are more likely to occur and improve the health outcomes of children with a chronic health condition.
Methods:
An open, unblinded, multi-centre randomised controlled trial in two Australian public hospitals. 112 children (0-16 years) fulfilling the inclusion criteria will be randomised to one of two clinical pathways for management of their chronic health condition: (1) integrated children's care clinic (ICCC) or (2) self-directed care pathway. All children and caregivers will be interviewed at 1 week, and 3, 6 and 12 month time intervals. Primary outcome measures include the Pediatric Quality of Life (PedQOL) questionnaire, Subjective Units of Distress Scale, Child Behaviour Checklist (CBCL) and Rotter's Locus of Control Scale. Secondary outcome measures include the total number of medical appointments, school days missed and quantity of services accessed. Our main objectives are to determine if the ICCC results in better health and economics outcomes compared to the self-directed care pathway.
Discussion:
The success of a health systems approach needs to be balanced against clinical, mortality and cost-effectiveness data for long-term sustainability within a publicly funded health system. A clinical pathway that is sustainable, cost-effective, provides efficient evidence-based care and improves the quality of life outcomes for children with chronic health conditions has the potential to reduce waitlist times, improve access to health services, increase consumer satisfaction; and prevent costs associated with poorly managed chronic health conditions into adulthood. This study will be the first to provide clinical and health economics data on an integrated care pathway for the management of chronic health conditions in children. On a broader scale, results from this study will help guide care coordination frameworks for children with chronic health conditions; particularly with the introduction and implementation of a National Disability Insurance Scheme (NDIS) across Australia.
Trial Registration:
Australia and New Zealand Clinical Trials Register (ANZCTR) ACTRN12617001188325 . Registered: 14th August, 2017.