Horton Courtney L, Heier Julie E, Barber John R, Brodie Nicola
Children's National Hospital, Washington, DC 20010, USA.
Division of General and Community Pediatrics, Children's National Hospital, Washington, DC 20010, USA.
Children (Basel). 2025 Mar 29;12(4):434. doi: 10.3390/children12040434.
Children with medical complexity (CMC), a subset of children with special healthcare needs, have chronic conditions affecting multiple organ systems, require medical technology, and account for a significant share of pediatric healthcare spending despite comprising only 1% of the population. Their families experience unique stressors, including financial strain and high rates of workforce attrition, suggesting medical inequity is an independent risk factor for health inequity. The role of universal caregiver stress screening using a validated tool within the outpatient primary care medical home for CMC youth has not been explored in the literature.
Caregivers of all patients in the Complex Care Program (CCP) within a large academic pediatric primary care Medical Home-certified practice at the Children's National Hospital were screened for caregiver stress during routine primary care appointments using the University of Washington Caregiver Stress Scale 8-Item Short Form V. 2.0 (UW-CSS). Elevated scores prompted referrals to the CCP psychosocial team, and composite scores were recorded in the electronic medical record. Demographics, medical diagnoses, and technology support status were extracted from the medical chart. The childhood opportunity index (COI) was calculated as a proxy for socioeconomic position.
Screening for caregiver stress in our medical home for CMC was feasible and yielded unexpected results. We found no difference in levels of stress among caregivers based on the COI. This finding highlights the importance of universal rather than targeted screening. Future directions include measuring the impact of targeted interventions for families who initially screen positive via longitudinal follow-up.
Screening for caregiver stress in a primary care medical home for CMC is feasible. As no single variable alone was a predictor of high caregiver stress, universal screening seems to be the most appropriate strategy to capture all families at the highest risk.
患有复杂疾病的儿童（CMC）是有特殊医疗需求儿童的一个子集，患有影响多个器官系统的慢性病，需要医疗技术，尽管仅占人口的1%，却占儿科医疗支出的很大一部分。他们的家庭面临独特的压力源，包括经济压力和高劳动力流失率，这表明医疗不平等是健康不平等的一个独立风险因素。在门诊初级保健医疗之家使用经过验证的工具对CMC青少年进行普遍的照顾者压力筛查的作用在文献中尚未得到探讨。
在儿童国家医院一家大型学术性儿科初级保健医疗之家认证机构的复杂护理项目（CCP）中，对所有患者的照顾者在常规初级保健预约期间使用华盛顿大学照顾者压力量表8项简表V. 2.0（UW-CSS）进行照顾者压力筛查。分数升高促使转诊至CCP心理社会团队，并将综合分数记录在电子病历中。从病历中提取人口统计学、医学诊断和技术支持状况。计算儿童机会指数（COI）作为社会经济地位的代理指标。
在我们为CMC设立的医疗之家中进行照顾者压力筛查是可行的，并产生了意想不到的结果。我们发现基于COI的照顾者压力水平没有差异。这一发现凸显了普遍筛查而非针对性筛查的重要性。未来的方向包括通过纵向随访来衡量针对最初筛查呈阳性的家庭进行的针对性干预的影响。
在为CMC设立的初级保健医疗之家中进行照顾者压力筛查是可行的。由于没有单一变量单独是高照顾者压力的预测指标，普遍筛查似乎是捕捉所有风险最高家庭的最合适策略。
