Drivers that decrease hospital-delivered care in children with medical complexity: Parental perspectives

Title

Drivers that decrease hospital-delivered care in children with medical complexity: Parental perspectives

Creator

Thibault LP; Bourque CJ; Gaucher N; Marano M; Couture K; Saad L; Chartrand C; Fregeau S; Dore-Bergeron MJ; Fiscaletti M; Kleiber N

Identifier

Publisher

Paediatrics and Child Health

Date

2024

Subject

Canada; Canadian; Children with medical complexity; Complex care; Complex care program; Delivery of health care; Disabled children; Patient centred care; adult; article; child; disabled child; emergency department visit; empowerment; female; health care cost; health care delivery; hospitalization; human; interview; length of stay; male; multidisciplinary team; nurse; person centered care; semi structured interview; thematic analysis; university hospital

Description

Background and objective: Children with medical complexity (CMC) have chronic and severe conditions leading to medical fragility. CMC represent less than 1% of children but account for one-third of paediatric healthcare expenditures. Enrollment to a complex care program (CCP) decreases health care resource utilization while improving parental satisfaction. An in-depth understanding of how these changes operate in real-world setting is needed to further support CMC and their families. This study aimed at assessing the possible reasons for a decrease in emergency department (ED) visits and hospitalization length of stay related to enrollment to a CCP, based on parental perspectives. Study design: Using a qualitative approach, data were collected using in-depth, semi-structured interviews with parents of CMC enrolled in a CCP from a university hospital centre in Montreal, Canada. The interview guide was co-constructed by an interdisciplinary team, including a parent partner and a clinical nurse coordinator. Themes have been identified inductively, using thematic analysis. Results: Parents identified personalized care, family empowerment and guidance as enablers arising from the CCP that contributed to the decrease in hospital-delivered care utilization. Improvement in medical baseline condition was also identified as a contributing factor, while not necessarily related to program's support. Conclusions: In this study, we identified personalized care, parental empowerment, and guidance as three strategies for a CCP to potentially decrease ED visits and hospital length of stay, from the parents' perspective. Parents identified the clinical nurse coordinator as playing a central role in supporting the implementation of these strategies. © 2023 The Author(s). Published by Oxford University Press on behalf of the Canadian Paediatric Society. All rights reserved.

Rights

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Citation List Month

November List 2024

Collection

Citation

Thibault LP; Bourque CJ; Gaucher N; Marano M; Couture K; Saad L; Chartrand C; Fregeau S; Dore-Bergeron MJ; Fiscaletti M; Kleiber N, “Drivers that decrease hospital-delivered care in children with medical complexity: Parental perspectives,” Pediatric Palliative Care Library, accessed February 7, 2025, https://pedpalascnetlibrary.omeka.net/items/show/19783.