Significant reductions in tertiary hospital encounters and less travel for families after implementation of Paediatric Care Coordination in Australia

Christie Breen,Yvonne Zurynski,Marie Deverell,Lisa Altman,Susan Woolfenden,Joanne Ging

doi:10.1186/s12913-018-3553-4

Abstract

BackgroundOver a third of Australian children have long-term health conditions, often involving multiple organ systems and resulting in complex health care needs. Our healthcare system struggles to meet their needs because of sectoral fragmentation and episodic models of care. Children with medical complexity (CMC) currently rely on tertiary paediatric hospitals for most of their healthcare, but this is not sustainable. We evaluated the impacts of Care Coordination on tertiary hospital service use and family outcomes.MethodsA pre- and post-implementation cohort evaluation of the Care Coordination service at a tertiary paediatric hospital network, was undertaken. From July 2015 CMC enrolled in the service had access to a Care Coordinator, shared-care plans, linkage with local general practitioners (GPs), and access to a 24-h Hotline from August 2016. CMC were those with ≥4 emergency department (ED) presentations, hospital stays of ≥14 days, or ≥ 10 outpatient appointments in 12 months. Medically fragile infants at risk of frequent future hospital utilisation, and children with medical problems complicated by difficult family psychosocial circumstances were also included. Care Coordinators collected outcomes for each enrolled child. Administrative data on hospital encounters 6 months pre- and post-enrolment were analysed for children aged > 6 months.ResultsAn estimated 557 hospital encounters, were prevented in the 6 months after enrolment, for 534 children aged > 6 months. ED presentations decreased by 40% (Chi2 = 37.95; P < 0.0001) and day-only admissions by 42% (Chi2 = 7.54; P < 0.01). Overnight admissions decreased by 9% but this was not significant. An estimated Au$4.9 million was saved over 2 years due to prevented hospital encounters. Shared-care plans were developed for 83.5%. Of 84 children who had no regular GP, 58 (69%) were linked with one. Fifty-five (10%) of families were linked to the 24-h Hotline to enable remote access to support and advice. Over 50,000 km of family travel and 370 school absences was prevented.ConclusionsThe Care Coordination service has clear benefits for the tertiary paediatric hospital network and for families. Ongoing evaluation is essential for continuous improvement and to support adjustments to the model according to the local context.

Highlights

Over a third of Australian children have long-term health conditions, often involving multiple organ systems and resulting in complex health care needs
In this paper we report implementation and evaluation outcomes of the Care Coordination service implemented in July 2015 at a large tertiary paediatric hospital network in Sydney, Australia
Enrolled children had a median age of 5 years, and approximately 43% lived in socio-economically disadvantaged areas (IRSAD < 5)

Summary

Introduction

Over a third of Australian children have long-term health conditions, often involving multiple organ systems and resulting in complex health care needs. The Australian Institute of Health and Welfare (AIHW), has estimated that approximately 37% of Australian children have at least one long-term health condition, and the number of children with medical complexity (CMC) is increasing [1]. The long-term conditions refer to conditions that last 6 months or more, or are expected to last 6 months or more [1] Most of these children have asthma, allergy or diabetes, children with a wide variety of diagnoses, which often involve multiple organ systems, and ongoing and complex health care needs, are known to access hospital, specialist and primary care services frequently [2]. The OECD concluded that: “...the Australian healthcare system is too complex for patients” especially for patients with chronic conditions [7]

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