Growing Evidence for Successful Care Management in Children With Medical Complexity.

Abstract

* Abbreviations: CARE — : Coordinating All Resources Effectively CMC — : children with medical complexity The last decade has heralded strategies to identify the population of children with medical complexity (CMC),1–3 quantify the striking magnitude of CMC health care costs,2,4–7 and document8–12 and address8,12,13 their unmet needs. Although dedicated programs designed to better coordinate CMC care (ie, “complex care”) have materialized rapidly,14 the rate of program growth has outpaced the generation of evidence for their effectiveness. Observational and uncontrolled studies have consistently suggested that complex care may lower costs by reducing hospital use15–18; however, 2 randomized controlled trials have yielded mixed results.19,20 The discrepancies in these randomized controlled trials introduce uncertainty about the anticipated cost savings from complex care programs around the country, whereas the array of distinct complex care program models creates ambiguity about how health systems and policymakers should promote implementation. In this month’s issue of Pediatrics , Bergman et al21 report findings from the Coordinating All Resources Effectively (CARE) learning collaborative, which … Address correspondence to Ryan J. Coller, MD, MPH, Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin–Madison, 600 Highland Ave, Madison, WI 53792. E-mail: rcoller{at}pediatrics.wisc.edu