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The management of children with medical complexity CMC is a central area in pediatric hospital medicine, as this population's healthcare demands are evolving. There is no universally agreed-upon definition for CMC; however, it generally encompasses children who exhibit high levels of family-identified needs, have severe chronic conditions that require complex care coordination, suffer from significant functional limitations necessitating medical technologies such as gastrostomy or tracheostomy, and display elevated utilization of healthcare resources. Conditions associated with these characteristics include but are not limited to quadriplegic cerebral palsy, muscular dystrophies, congenital myopathies, high myelomeningoceles, and glycogen storage diseases like Morquio syndrome.
The conceptual framework for CMC includes these four core aspects:
High Levels of Family-Identified Needs: These children often require extensive family support due to the complexity and severity of their conditions.
Severe Chronic Conditions: This refers to disorders with long-term impacts that significantly affect quality of life, such as those mentioned above.
Significant Functional Limitations: They may have limitations in dly activities requiring assistance for mobility, communication, or self-care.
Elevated Health Resource Utilization: Frequent hospital visits and a high consumption of medical resources are common features.
Administrative identification methods like diagnostic codes e.g., ICD-9, the 3M Clinical Risk Groups CRG, Neurological Imprment codes, and the National Survey of Children with Special Healthcare Needs have been used to identify CMC. Studies suggest that this group comprises about 0.4 of children in a population level analysis.
As definitions for CMC evolve, research indicates that these children are increasingly present in hospital settings. Children identified as having complex chronic conditions or those assigned higher CRG levels account for an increasing number of hospitalizations and days spent at U.S. children's hospitals, with rates showing a rise by 33 over the last decade. Moreover, having a complex chronic condition serves as an indepent risk factor for adverse patient safety events.
In terms of healthcare system demands, CMC populations are attracting significant attention due to frequent hospital admissions and higher resource utilization. This has sparked interest in identifying effective strategies to reduce costs while mntning care quality.
Pediatric hospitalists play a pivotal role in caring for children with medical complexity through various capacities:
Inpatient Management: Hospitalists may take on direct responsibility for admitting patients requiring intensive care or consultation services, such as those with aspiration pneumonia, exacerbations of asthma or chronic lung diseases, feeding issues, complex wound care management, elective surgical procedures, and complications related to technology-assistance devices.
Consultation Services: When children are admitted to subspecialty departments or present in the emergency department, hospitalists often provide expert advice on patient care.
Sedative Management: Hospitalists offering sedation services may be consulted for decisions regarding appropriate use of sedatives in light of existing medical complexities.
In this dynamic field, pediatric hospitalists m to deliver comprehensive and coordinated care, ensuring that children with medical complexity receive the necessary support and resources throughout their healthcare journey.
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Complex Medical Needs in Pediatrics Pediatric Hospital Medicine Focus Children with Medical Complexity Care Healthcare Demands for Complex Cases Evolving Definitions of CMC Role of Pediatric Hospitalists