Department of Public Health Sciences, Clemson University, 501 Epsilon Zeta Dr. (Edwards Hall), Clemson, SC, 29634, USA.
Vanderbilt University Medical Center, Nashville, TN, 37232, USA.
BMC Health Serv Res. 2024 Jul 15;24(1):814. doi: 10.1186/s12913-024-11235-1.
Children with medical complexity (CMC) comprise < 1% of the pediatric population, but account for nearly one-third of healthcare expenditures. Further, while CMC account for up to 80% of pediatric inpatient hospital costs, only 2% of Medicaid spending is attributed to home healthcare. As a result, the current health system heavily relies on family caregivers to fill existing care gaps. This study aimed to: (1) examine factors associated with hospital admissions among CMC and (2) contextualize the potential for home nursing care to improve outcomes among CMC and their families in South Carolina (SC).
This mixed-methods study was conducted among CMC, their family caregivers, and physicians in SC. Electronic health records data from a primary care clinic within a large health system (7/1/2022-6/30/2023) was analyzed. Logistic regression examined factors associated with hospitalizations among CMC. In-depth interviews (N = 15) were conducted among physicians and caregivers of CMC statewide. Patient-level quantitative data is triangulated with conceptual findings from interviews.
Overall, 39.87% of CMC experienced ≥ 1 hospitalization in the past 12 months. CMC with higher hospitalization risk were dependent on respiratory or neurological/neuromuscular medical devices, not non-Hispanic White, and demonstrated higher healthcare utilization. Interview findings contextualized efforts to reduce hospitalizations, and suggested adaptations related to capacity and willingness to provide complex care for CMC and their families.
Findings may inform multi-level solutions for accessible, high-quality home nursing care among CMC and their families. Providers may learn from caregivers' insight to emphasize family-centered care practices, acknowledging time and financial constraints while optimizing the quality of medical care provided in the home.
患有复杂疾病的儿童（CMC）占儿科人口的<1%，但却占医疗保健支出的近三分之一。此外，尽管 CMC 占儿科住院患者医疗费用的 80%，但医疗补助支出中只有 2%用于家庭医疗保健。因此，现行的医疗体系严重依赖家庭照顾者来填补现有护理缺口。本研究旨在：（1）研究与 CMC 住院相关的因素；（2）从背景出发，研究家庭护理对改善南卡罗来纳州（SC）CMC 及其家庭的预后的潜力。
这是一项在 SC 中的 CMC、其家庭照顾者和医生中进行的混合方法研究。分析了一家大型医疗系统内初级保健诊所的电子健康记录数据（2022 年 7 月 1 日至 2023 年 6 月 30 日）。逻辑回归分析了与 CMC 住院相关的因素。对 SC 全州的 CMC 医生和照顾者进行了深入访谈（N=15）。患者层面的定量数据与访谈中的概念性发现进行了三角分析。
总体而言，39.87%的 CMC 在过去 12 个月中经历了≥1次住院治疗。具有更高住院风险的 CMC 依赖于呼吸或神经/神经肌肉医疗设备，非非西班牙裔白人，并且表现出更高的医疗保健利用率。访谈结果为减少住院提供了背景信息，并提出了与能力和为 CMC 及其家庭提供复杂护理的意愿相关的适应性调整。
研究结果可能为 CMC 及其家庭获得可及、高质量的家庭护理提供多层次的解决方案。医疗服务提供者可以从照顾者的角度出发，学习家庭为中心的护理实践，在承认时间和财务限制的同时，优化家庭医疗护理的质量。
