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American Academy of Pediatrics
Research Articles

Point-of-Care Complexity Screening Algorithm to Identify Children With Medical Complexity

Victoria Parente, Lisa Parnell, Julie Childers, Tracy Spears, Valerie Jarrett and David Ming
Hospital Pediatrics January 2021, 11 (1) 44-51; DOI: https://doi.org/10.1542/hpeds.2020-0066
Victoria Parente
aDepartments of Pediatrics and
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Lisa Parnell
aDepartments of Pediatrics and
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Julie Childers
bUniversity of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and
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Tracy Spears
cDuke Clinical Research Institute, Durham, North Carolina
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Valerie Jarrett
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David Ming
aDepartments of Pediatrics and
dMedicine, School of Medicine, Duke University, Durham, North Carolina;
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Abstract

OBJECTIVES: For pediatric complex care programs to target enhanced care coordination services to the highest-risk patients, it is critical to accurately identify children with medical complexity (CMC); however, no gold standard definition exists. The aim of this study is to describe a point-of-care screening algorithm to identify CMC with high health care use, a group that may benefit the most from improved care coordination.

METHODS: From July 1, 2015, to June 30, 2016 (fiscal year 2016 [FY16]), a medical complexity screening algorithm was implemented by a pediatric complex care program at a single tertiary care center for hospitalized patients at the time of admission. Using the screening algorithm, we categorized inpatients into 1 of 3 groups: CMC, children with special health care needs (CSHCN), or previously healthy (PH) children. Inpatient resource use for FY16 and FY17 encounters was extracted for children screened in FY16.

RESULTS: We categorized 2187 inpatients in FY16 into the 3 complexity groups (CMC = 77; CSHCN = 1437; PH children = 673). CMC had more complex chronic conditions (median = 6; interquartile range [IQR] 4–11) than CSHCN (median = 1; IQR 0–2) and PH children (median = 0; IQR 0–0). CMC had greater per-patient and per-encounter hospital use than CSHCN and PH children. CMC and children with ≥4 complex chronic conditions had comparable levels of resource use.

CONCLUSIONS: By implementation of a point-of-care screening algorithm, we identified CMC with high health care use. By using this algorithm, it was feasible to identify hospitalized CMC that could benefit from care coordination by a pediatric complex care program.

  • Copyright © 2021 by the American Academy of Pediatrics
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Hospital Pediatrics: 11 (1)
Hospital Pediatrics
Vol. 11, Issue 1
1 Jan 2021
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Point-of-Care Complexity Screening Algorithm to Identify Children With Medical Complexity
Victoria Parente, Lisa Parnell, Julie Childers, Tracy Spears, Valerie Jarrett, David Ming
Hospital Pediatrics Jan 2021, 11 (1) 44-51; DOI: 10.1542/hpeds.2020-0066

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Point-of-Care Complexity Screening Algorithm to Identify Children With Medical Complexity
Victoria Parente, Lisa Parnell, Julie Childers, Tracy Spears, Valerie Jarrett, David Ming
Hospital Pediatrics Jan 2021, 11 (1) 44-51; DOI: 10.1542/hpeds.2020-0066
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