Harvey Adrienne, Shepherd Daisy, Gibb Susan, Baikie Gordon, D'Aprano Anita, Reddihough Dinah, Babic Rose, Hunter Frances, Jealous Gretta, Imms Christine
Neurodisability and Rehabilitation, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
J Paediatr Child Health. 2024 Dec;60(12):815-824. doi: 10.1111/jpc.16690. Epub 2024 Oct 9.
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.
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.
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).
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.
针对患有复杂医疗状况的脑瘫（CP）儿童的综合护理项目已经存在；然而，其影响的证据有限。本研究（i）探讨了皇家儿童医院综合护理中心（CCH）在3年期间对患有复杂医疗状况的CP儿童与符合条件但接受常规护理的儿童相比，对医院服务利用率的影响，以及（ii）比较了两组儿童及其家庭的健康、残疾和社会人口学特征。
纳入了78名（平均年龄9.43岁，女性n = 37）接受CCH服务的患有复杂医疗状况的CP儿童和92名（平均年龄10.86岁，女性，n = 39）接受常规护理的儿童的电子病历数据。采用多变量回归分析服务利用率：急诊科就诊次数、住院和重症监护病房住院时间/次数以及医院预约次数/类型。比较了每组的关键医疗需求、功能/残疾状况以及儿童/家庭人口统计学特征。
CCH组中更多儿童为混合型运动类型（73.1%对15.2%），被归类为粗大运动功能分类系统V级（76.9%对34.8%），有呼吸、营养和社会支持需求以及癫痫。接受CCH服务的儿童有更高的服务利用率；急诊科就诊（率比（RR）= 1.81，95%置信区间（CI）：1.09 - 3.01）、住院（RR = 2.77，95% CI：2.01 - 3.83）、门诊就诊（RR = 1.69，95% CI：1.31 - 2.18）和电话问诊（RR = 6.05，95% CI：4.56 - 8.02）。
接受综合护理服务的患有复杂医疗状况的CP儿童有更高的服务利用率，但临床表现更复杂且支持需求更高。
