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Understanding case mix across three paediatric services: could integration of primary and secondary general
Lloyd Steele1, Nicky Coote1, Robert Klaber1
1Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK.
Insights
Over half of acute paediatric service attendances could be managed in the community. Integrated paediatric care can address parental needs and improve community-based management of chronic conditions.
Area of Science:
- Paediatric healthcare services
- Integrated care models
- Healthcare service evaluation
Background:
- Understanding the case mix in paediatric services is crucial for optimizing care delivery.
- Developing integrated care systems requires analysis of current service utilization patterns.
- Identifying alternative management settings for acute paediatric attendances is key to efficiency.
Purpose of the Study:
- To analyze the case mix of three distinct paediatric services.
- To determine reasons for utilizing acute paediatric services in a developing integrated care region.
- To assess where acute paediatric attendances could be managed alternatively.
Main Methods:
- A mixed-methods service evaluation was conducted.
- Retrospective review of general paediatric outpatient referrals (n=534) and a virtual integrated service (email advice line, n=474).
- Prospective survey of paediatric ambulatory unit (PAU) attendees (n=95) with consultant/registrar review for alternative management suitability.
Main Results:
- PAU case mix was more acute than outpatient referrals or the email advice line.
- Primary parental reasons for PAU attendance included community health professional referral (27.2%), difficulty accessing general practitioner (GP) appointments (21.7%), and avoiding accident and emergency (A&E) (17.4%).
- Over 50% of PAU presentations were deemed suitable for community management by a GP or midwife, with 85% of those unable to access a GP appointment being appropriate for community care.
Conclusions:
- Approximately 50% of acute paediatric service attendances are manageable within the community setting.
- Integrated paediatric services can effectively address parental reasons for seeking acute care.
- Enhanced integration can facilitate better community-based management of chronic paediatric conditions.
Objective:
To understand the case mix of three different paediatric services, reasons for using an acute paediatric service in a region of developing integrated care and where acute attendances could alternatively have been managed.
Methods:
Mixed methods service evaluation, including retrospective review of referrals to general paediatric outpatients (n=534) and a virtual integrated service (email advice line) (n=474), as well as a prospective survey of paediatric ambulatory unit (PAU) attendees (n=95) and review by a paediatric consultant/registrar to decide where these cases could alternatively have been managed.
Results:
The case mix of outpatient referrals and the email advice line was similar, but the case mix for PAU was more acute. The most common parental reasons for attending PAU were referral by a community health professional (27.2%), not being able to get a general practitioner (GP) appointment when desired (21.7%), wanting to avoid accident and emergency (17.4%) and wanting specialist paediatric input (14.1%). More than half of PAU presentations were deemed most appropriate for community management by a GP or midwife. The proportion of cases suitable for community management varied by the reason for attendance, with it highestl for parents reporting not being able to get a GP appointment (85%), and lowest for those referred by community health professionals (29%).
Conclusions:
One in two attendances to acute paediatric services could have been managed in the community. Integration of paediatric services could help address parental reasons for attending acute services, as well as facilitating the community management of chronic conditions.
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