Children’s Hospital of Pittsburgh of UPMC Report Provides Recommendations for Improving Management of Children with Medical Complexity

November 21, 2016

Care of children with medical complexity who have significant chronic health problems resulting in extensive health care needs require an optimized framework with the medical home as the foundation of an integrated care system, according to a new American Academy of Pediatrics clinical report published online today in the journal Pediatrics.

The clinical report, led by Amy Houtrow, M.D., Ph.D., M.P.H., chief, Division of Pediatric Rehabilitation Medicine at Children's Hospital of Pittsburgh of UPMC, and Dennis Kuo, M.D., M.H.S., chief, Division of General Pediatrics, UBMD Pediatrics/Women & Children's Hospital of Buffalo, notes that opportunities exist for health care providers, payers and policy makers to develop strategies to enhance care delivery and to decrease costs.

One-third of overall health care spending on children is accounted for by 1 percent—children with medical complexity. A medically complex child, for example, may have a genetic condition associated with congenital heart defect, difficulty with swallowing, cerebral palsy and a urologic condition.

“While there aren’t many children who are medically complex, it is important for schools, daycares and hospitals to pay special attention to them because of their extensive needs,” said Dr. Houtrow, also associate professor of physical medicine and rehabilitation and pediatrics, University of Pittsburgh School of Medicine. “Educating pediatricians and other health care providers to understand how to help care for children with medical complexity will help to improve treatment and care.”

Outcomes include decreasing unplanned hospital admissions, decreasing emergency department use, ensuring access to health services, limiting out-of-pocket expenses for families, and improving patient and family experiences, quality of life and satisfaction with care.

The overall objective of any framework of care for children with medical complexity should be to maximize health, development and family functioning through coordinated patient- and family centered care along with providing proactive, rather than reactive care to avert critical medical and health events as much as possible, according to the authors of the report.

For more information on Dr. Houtrow and the Division of Pediatric Rehabilitation Medicine, visit