Identifying Children With Medical Complexity for Care Coordination in Primary Care Settings

Area of Science:

• Pediatrics
• Healthcare Management
• Nursing

Background:

• Children with medical complexity (CMC) often require extensive subspecialty care.
• Identifying CMC accurately is crucial for effective care coordination.
• Pediatric practices face challenges in managing the needs of CMC.

Purpose of the Study:

• To characterize a cohort of 98 children with medical complexity (CMC) insured by Medicaid.
• To evaluate the effectiveness of embedded nurse care coordination for CMC.
• To determine reliable criteria for identifying CMC who would benefit most from care coordination.

Main Methods:

• Retrospective cohort study of 98 children with medical complexity.
• Analysis of subspecialist engagement and diagnoses.
• Application of primary and secondary definitions for medical complexity.

Main Results:

• 90% of enrolled children required 3 or more subspecialists.
• Neurology, orthopedic surgery, endocrinology, and gastroenterology were most frequent subspecialties.
• 64% had expected neurodevelopmental disabilities; 98% met a broader definition of CMC.

Conclusions:

• A significant proportion of children in pediatric practice exhibit medical complexity.
• Established criteria for identifying CMC are vital for optimizing care coordination.
• The implemented method for identifying CMC was successful in this cohort.