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Initiatives needed to improve health outcomes and decrease costs for children with medical complexity


Children with medical complexity (CMC) account for less than one per cent of the entire child population but require almost one-third of all pediatric healthcare services, according to new research by the Institute for Clinical Evaluative Sciences (ICES). The researchers say that improving aspects of care delivery, such as care coordination, could improve these children’s lives and reduce unnecessary healthcare utilization and costs.

CMC are defined as children who have complex underlying chronic health conditions that are typically associated with significant functional status limitations. These children may have a congenital or acquired multisystem disease, a severe neurologic condition with marked functional impairment, and/or technology dependence for activities of daily living.

“We know that children with medical complexity are high users of acute healthcare, but there is little information on what types or amounts of healthcare they are using. This information is essential to improve aspects of care delivery and population-based health planning and policy,” says Dr. Astrid Guttmann, senior investigator, ICES senior scientist and pediatrician at The Hospital for Sick Children (SickKids).

The retrospective cohort study examined 340,786 children hospitalized in Ontario from April 1, 2005 to March 31, 2007 and found that:

  • 15,771 (4.6 per cent) were CMC, representing 0.67 per cent of children in Ontario.
  • CMC are cared for by many different healthcare providers in many different places over time and they are therefore at risk of poor care coordination.
  • These children accounted for almost one-third of all healthcare spending on children.
  • Re-hospitalization accounted for the largest proportion of subsequent costs (27.2 per cent).

“These children make multiple transitions across providers and care settings. Therefore, initiatives to improve their health outcomes and decrease costs need to focus on better coordination of their care across the entire continuum from the hospital to the doctor’s office to the home,” says Dr. Eyal Cohen, lead author and pediatrician at SickKids.

Authors: Eyal Cohen, Jay Barry, Ximena Camacho, Geoffrey Anderson, Walter Wodchis, Astrid Guttmann.

The study “Patterns and costs of healthcare use of children with medical complexity,” was published today in Pediatrics.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.


Read the Journal Article