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Most Children With Medical Complexity Do Not Receive Care in Well-Functioning Health Care Systems
Justin A Yu1,2, Gina McKernan3,4, Thomas Hagerman5
1Divisions of Pediatric Hospital Medicine and Palliative and Supportive Care, yuja@upm.edu.
Insights
Children with medical complexity (CMC) have significantly less access to well-functioning healthcare systems compared to other children with special health care needs (CSHCN). This disparity persists across all income levels, highlighting a critical gap in care.
Area of Science:
- Pediatric Health Services Research
- Health Care Access
- Complex Care Management
Background:
- Children with medical complexity (CMC) represent a vulnerable population requiring coordinated and effective healthcare.
- Access to well-functioning healthcare systems is crucial for optimal outcomes in CMC.
- Existing research indicates potential disparities in healthcare experiences for CMC.
Purpose of the Study:
- To evaluate the access of CMC to well-functioning healthcare systems.
- To examine the association between medical complexity and access to quality care.
- To identify factors influencing healthcare system performance for CMC.
Main Methods:
- Secondary analysis of the National Survey of Children's Health (2016-2017).
- Utilized χ² analyses and adjusted multivariable logistic regression.
- Investigated the interaction between medical complexity and household income.
Main Results:
- CMC (1.6% of sample) had significantly lower odds (OR=0.3) of receiving care in a well-functioning system compared to CSHCN.
- Lower attainment rates were observed for CMC regarding family partnership, medical home integration, and access to needed care.
- While family income was associated with care access, it did not modify the relationship between medical complexity and outcomes.
Conclusions:
- CMC experience significant barriers in accessing well-functioning healthcare systems, irrespective of income.
- Current healthcare systems require adaptation to better meet the unique needs of CMC.
- Targeted interventions are needed to improve care coordination and access for this population.
Objectives:
To describe the access of children with medical complexity (CMC) to well-functioning health care systems. To examine the relationships between medical complexity status and this outcome and its component indicators.
Patients And Methods:
Secondary analysis of children in the National Survey of Children's Health combined 2016-2017 data set who received care in well-functioning health systems. Secondary outcomes included this measure's component indicators. The χ2 analyses were used to examine associations between child and family characteristics and the primary outcome. Adjusted multivariable logistic regression was used to examine relationships between medical complexity status and primary and secondary outcomes. Using these regression models, we examined the interaction between medical complexity status and household income.
Results:
CMC accounted for 1.6% of the weighted sample (n = 1.2 million children). Few CMC (7.6%) received care in a well-functioning health care system. CMC were significantly less likely than children with special health care needs (CSHCN) (odds ratio, 0.3) of meeting criteria for this primary outcome. Attainment rates for secondary outcomes (families feeling like partners in care; receives care within a medical home; received needed health care) were significantly lower among CMC than CSHCN. Family income was significantly associated with likelihood of meeting criteria for primary and secondary outcomes; however, the relationships between medical complexity status and our outcomes did not differ by income level.
Conclusions:
CMC are less likely than other CSHCN to report receiving care in well-functioning health care systems at all income levels. Further efforts are necessary to better adapt current health care systems to meet the unique needs of CMC.
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