Impact of care coordination on service utilisation for children with medically complex cerebral palsy

Impact of care coordination on service utilisation for children with medically complex cerebral palsy

Harvey A; Shepherd D; Gibb S; Baikie G; D'Aprano A; Reddihough D; Babic R; Hunter F; Jealous G; Imms C

Journal of Paediatrics and Child Health

2024

cerebral palsy; medical complexity; chronic conditions; care coordination

Aim: Complex care programmes for children with medically complex cerebral palsy (CP) exist; however, evidence for their impact is limited. This study (i) explored the impact of The Royal Children's Hospital Complex Care Hub (CCH) on hospital service utilisation rates over a 3-year period for children with medically complex CP compared with those eligible but received routine care, and (ii) compared health, disability and socio-demographic characteristics of children and their families in both groups. Methods: Electronic medical record data from 78 children (mean age 9.43 years, females n = 37) with medically complex CP who accessed CCH services, and 92 (mean age 10.86 years, females, n = 39) who received routine care were included. Multivariable regression was used to analyse service utilisation: number of emergency department (ED) presentations, length/number of inpatient and intensive care unit admissions and number/type of hospital appointments. Critical health-care needs, functioning/disability profile and child/family demographics for each group were compared. Results: More children in the CCH group had a mixed motor type (73.1% vs. 15.2%), were classified within Gross Motor Function Classification System level V (76.9% vs. 34.8%), had respiratory, nutrition and social support needs and epilepsy. Children receiving CCH services had higher service utilisation rates; ED presentations (rate ratio (RR) = 1.81, 95% confidence interval (CI): 1.09–3.01), inpatient admissions (RR = 2.77, 95% CI: 2.01–3.83), outpatient encounters (RR = 1.69, 95% CI: 1.31–2.18) and telephone encounters (RR = 6.05, 95% CI: 4.56–8.02). Conclusions: Children with medically complex CP accessing a complex care service have higher service utilisation rates yet have more complex clinical presentations and higher support needs. © 2024 The Author(s). Journal of Paediatrics and Child Health published by John Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

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