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Identifying children with medical complexity in administrative datasets in a Canadian context: study protocol
Holly McCulloch1, Sydney Breneol2, Samuel A Stewart3
1Children's Health Program, IWK Health Centre, Halifax, Nova Scotia, Canada.
Insights
This study identifies children with medical complexity in the Canadian Maritimes using administrative data. Findings will inform healthcare resource allocation for this vulnerable pediatric population.
Area of Science:
- Pediatric Health Services Research
- Health Informatics
- Population Health Management
Background:
- Children with medical complexity (CMC) represent a small but high-need pediatric population, accounting for significant healthcare expenditures.
- Accurate identification of CMC is crucial for researching care disparities and optimizing health resource allocation in Canada.
- The Canadian Maritimes (Nova Scotia, New Brunswick, Prince Edward Island) have a unique healthcare landscape requiring tailored approaches to identify CMC.
Purpose of the Study:
- To evaluate algorithms for identifying CMC in Canadian Maritime administrative data.
- To estimate the prevalence of CMC in the Canadian Maritimes from 2003-2017.
- To describe healthcare utilization patterns among CMC in this region.
Main Methods:
- A gold-standard definition for pediatric medical complexity will be co-developed with an expert panel.
- Algorithm performance will be validated using a two-gate process with Nova Scotia data.
- The best-performing algorithm will be applied to administrative data from Nova Scotia, New Brunswick, and Prince Edward Island.
Main Results:
- Algorithm performance evaluation results are pending.
- Prevalence estimates for CMC in the Canadian Maritimes are pending.
- Healthcare utilization patterns for CMC are pending.
Conclusions:
- This research will establish a reliable method for identifying CMC in the Canadian Maritimes.
- Findings will provide critical data on CMC prevalence and healthcare use, informing policy and practice.
- The study employs an integrated knowledge translation approach to maximize research impact.
Introduction:
Children with medical complexity and their families are an important population of interest within the Canadian healthcare system. Despite representing less than 1% of the paediatric population, children with medical complexity require extensive care and account for one third of paediatric healthcare expenditures. Opportunities to conduct research to assess disparities in care and appropriate allocation of health resources relies on the ability to accurately identify this heterogeneous group of children. This study aims to better understand the population of children with medical complexity in the Canadian Maritimes, including Nova Scotia (NS), New Brunswick (NB) and Prince Edward Island (PEI). This will be achieved through three objectives: (1) Evaluate the performance of three algorithms to identify children with medical complexity in the Canadian Maritimes in administrative data; then using the 'best fit' algorithm (2) Estimate the prevalence of children with medical complexity in the Canadian Maritimes from 2003 to 2017 and (3) Describe patterns of healthcare utilisation for this cohort of children across the Canadian Maritimes.
Methods And Analysis:
The research will be conducted in three phases. In Phase 1, an expert panel will codevelop a gold-standard definition of paediatric medical complexity relevant to the Canadian Maritime population. A two-gate validation process will then be conducted using NS data and the gold-standard definition to determine the 'best fit' algorithm. During phase 2 the 'best fit' algorithm will be applied to estimate the prevalence of children with medical complexity in NS, NB and PEI. Finally, in phase 3 will describe patterns of healthcare utilisation across the Canadian Maritimes.
Ethics And Dissemination:
Ethics approval for this protocol was granted by the institutional research ethics board at the IWK Health Centre (REB # 1026245). A waiver of consent was approved. This study will use an integrated knowledge translation approach, where end users are involved in each stage of the project, which could increase uptake of the research into policy and practice. The findings of this research study will be submitted for publication and dissemination through conference presentations and with our end users.
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