Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada;
Department of Pediatrics and Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
Pediatrics. 2018 Mar;141(Suppl 3):S202-S211. doi: 10.1542/peds.2017-1284E.
Discourse about childhood chronic conditions has transitioned in the last decade from focusing primarily on broad groups of children with special health care needs to concentrating in large part on smaller groups of children with medical complexity (CMC). Although a variety of definitions have been applied, the term CMC has most commonly been defined as children and youth with serious chronic conditions, substantial functional limitations, increased health and other service needs, and increased health care costs. The increasing attention paid to CMC has occurred because these children are growing in impact, represent a disproportionate share of health system costs, and require policy and programmatic interventions that differ in many ways from broader groups of children with special health care needs. But will this change in focus lead to meaningful changes in outcomes for children with serious chronic diseases, or is the pediatric community simply adopting terminology with resonance in adult-focused health systems? In this article, we will explore the implications of the rapid emergence of pediatric complex care in child health services practice and research. As an emerging field, pediatric care systems should thoughtfully and rapidly develop evidence-based solutions to the new challenges of caring for CMC, including (1) clearer definitions of the target population, (2) a more appropriate incorporation of components of care that occur outside of hospitals, and (3) a more comprehensive outcomes measurement framework, including the recognition of potential limitations of cost containment as a target for improved care for CMC.
关于儿童慢性疾病的讨论在过去十年中已经从主要关注有特殊医疗需求的广泛儿童群体转变为主要关注少数医疗复杂的儿童（CMC）。尽管已经应用了各种定义，但 CMC 一词最常被定义为患有严重慢性疾病、功能严重受限、健康和其他服务需求增加以及医疗费用增加的儿童和青少年。越来越关注 CMC 的原因是这些儿童的影响越来越大，他们占卫生系统成本的不成比例份额，并且需要政策和计划干预措施，这些措施在许多方面与有特殊医疗需求的更广泛的儿童群体不同。但是，这种关注焦点的转变是否会导致患有严重慢性疾病的儿童的结局发生有意义的变化，还是儿科界只是在采用在成人为重点的卫生系统中具有共鸣的术语？在本文中，我们将探讨儿童健康服务实践和研究中儿童复杂护理快速出现的影响。作为一个新兴领域，儿科护理系统应该深思熟虑并迅速为照顾 CMC 的新挑战制定基于证据的解决方案，包括（1）更明确地定义目标人群，（2）更适当地纳入医院以外发生的护理组成部分，以及（3）更全面的结果衡量框架，包括认识到以成本控制为目标可能会限制改善 CMC 护理的潜力。
