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Predominant Clinicians and Care Settings for Young Military-Connected Children with Medical Complexity
Dana N Joseph1, Jackielyn Lanning2, Mary Arakelyan3
1Geisel School of Medicine at Dartmouth (DN Joseph), Hanover, NH.
Insights
Most military children with medical complexity receive care in both military and civilian settings. Reliance on civilian clinicians increases with age and complexity, highlighting the need for coordinated care.
Area of Science:
- Pediatric Healthcare
- Military Health Systems
- Complex Chronic Conditions
Background:
- Military-connected children with medical complexity (CMC) have unique and multifaceted healthcare needs.
- Understanding care delivery patterns is crucial for optimizing healthcare for this population.
Purpose of the Study:
- To describe ambulatory care settings for young military-connected CMC.
- To identify the predominant clinicians involved in their care.
- To determine factors associated with predominant care in civilian facilities.
Main Methods:
- Retrospective cohort study using US military Birth and Infant Health Research data (2009-2020).
- Identified CMC (<5 years) using Complex Chronic Condition and Pediatric Medical Complexity algorithms.
- Analyzed care settings and identified predominant clinicians using generalized estimating equations.
Main Results:
- 68.7% of CMC received care in both military and civilian facilities.
- Predominant civilian clinician care increased from 45.5% in infancy to 54.5% by age five.
- Preterm delivery, older diagnosis age, multisystem disease, and technology dependence were linked to civilian predominant care.
Conclusions:
- A significant majority of young military-connected CMC utilize both military and civilian healthcare sectors.
- Care reliance shifts towards civilian facilities as children age and their medical complexity increases.
- Emphasizes the critical need for integrated care coordination across healthcare sectors for military-connected CMC.
Objective:
Military-connected children with medical complexity (CMC) have multifaceted healthcare needs. This study describes the share of ambulatory care delivered to young military-connected CMC within civilian and military health facilities, identifies the predominant clinician providing care, and identifies factors associated with having a predominant clinician at a civilian health facility.
Methods:
This retrospective cohort study analyzed United States military Birth and Infant Health Research program data, 2009-2020. The Complex Chronic Condition and Pediatric Medical Complexity algorithms were used to identify CMC <5 years. The clinician and care setting for each ambulatory care visit were determined, and the clinician providing the plurality of care each year from birth through 5 years was identified. Generalized estimating equations were used to identify factors associated with having a predominant clinician at a civilian health facility.
Results:
Among 66,920 CMC, 68.7% (n = 46,001) received care at both military and civilian health facilities. The proportion with a predominant clinician at a civilian facility ranged from 45.5% (n = 17,953) during infancy to 54.5% (n = 28,568) by five years. Child-level factors associated with having a civilian predominant clinician included preterm delivery, older age at diagnosis, multisystem disease, and technology dependence.
Conclusions:
Two-thirds of military-connected young CMC received ambulatory care across both military and civilian facilities, with increasing reliance on clinicians at civilian facilities beyond infancy and as complexity increased. These findings highlight the importance of coordinated care across healthcare sectors to address the unique needs of military-connected CMC and their families.
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