Duke-Margolis Center for Health Policy (S Sandhu), Durham, NC; Harvard Medical School (S Sandhu), Boston, Mass.
Departments of Pediatrics, Medicine, and Population Health Sciences (DY Ming), Duke University School of Medicine, Durham, NC.
Acad Pediatr. 2022 Aug;22(6):1041-1048. doi: 10.1016/j.acap.2022.01.011. Epub 2022 Jan 26.
Children with complex health needs (CCHN) have both medical (eg, chronic conditions) and health-related social needs (eg, potentially adverse social determinants of health) that require ongoing health care and support from multiple community service providers. National standards developed for populations defined by health needs (CYSHCN) provide a framework for stakeholders to plan system-level improvements in care delivery for CCHN, but improvement efforts should reflect the priorities of their families and providers. This article describes a process of prioritizing system-level efforts to improve the health and well-being of CCHN and families in North Carolina (NC), using systematic stakeholder engagement and modified Delphi expert ratings.
We surveyed stakeholders with experience caring for CCHN using an open-ended, 3-item instrument to identify opportunities to improve systems of care. Using directed qualitative content analysis, we synthesized responses into a master list of potential improvement topics. Using a modified Delphi approach, a 16-member advisory committee rated all topics for importance and urgency, on 9-point Likert scales over 2 rounds; then ratings for each topic were ranked (low, medium, high) to establish relative priority.
Forty seven individuals from 31 counties around NC provided survey responses, yielding 59 improvement topics in 10 domains. Through the modified Delphi method process, 21 topics (36%) received the highest rankings, largely representing access to community- and home-based services, equity, and enhancement of the pediatric workforce.
Priorities identified by stakeholders will inform advocacy, policy, and improvement efforts. Next steps for the coalition include developing improvement projects to implement stakeholder-recommended actions for the highest-priority topics.
患有复杂健康需求的儿童（CCHN）既有医疗需求（例如慢性疾病），也有与健康相关的社会需求（例如潜在的健康决定因素不利），这些需求需要持续的医疗保健和来自多个社区服务提供者的支持。为满足健康需求的人群（CYSHCN）制定的国家标准为利益相关者提供了一个框架，用于规划 CCHN 护理服务提供方面的系统级改进，但改进工作应反映其家庭和提供者的优先事项。本文描述了北卡罗来纳州（NC）使用系统的利益相关者参与和修改后的 Delphi 专家评分来确定优先考虑系统级努力以改善 CCHN 和家庭健康和福祉的过程。
我们使用开放式、3 项的工具对有照顾 CCHN 经验的利益相关者进行了调查，以确定改善护理系统的机会。使用定向定性内容分析，我们将回应综合成潜在改进主题的总清单。使用修改后的 Delphi 方法，一个由 16 名成员组成的顾问委员会对所有主题的重要性和紧迫性进行了 9 点李克特量表的两轮评分；然后对每个主题的评分进行排名（低、中、高），以确定相对优先级。
北卡罗来纳州 31 个县的 47 人提供了调查答复，产生了 10 个领域的 59 个改进主题。通过修改后的 Delphi 方法过程，21 个主题（36%）获得了最高排名，主要代表了获得社区和家庭服务、公平和增强儿科劳动力的机会。
利益相关者确定的优先事项将为宣传、政策和改进工作提供信息。联盟的下一步行动包括制定改进项目，以实施利益相关者推荐的针对最高优先级主题的行动。
