Hospitalist Care of the Medically Complex Child

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Defining the medically complex child

Defining this population has been challenging for health services researchers and clinicians. Several recent initiatives have shaped the current conceptual model. In 2001, the Institute of Medicine recommended that the Agency for Health care Research and Quality identify “15 priority conditions, taking into account frequency of occurrence, health burden, and resource use” [3]. The Institute of Medicine identified children with special health care needs (CSHCN) as a priority population [3], [4].

Unique issues of inpatient care

A comprehensive approach by pediatric hospitalists is essential for delivering effective, efficient, coordinated, and family-centered care that best meets the multifaceted needs of these children and their families. Twenty-two percent of recurrent hospital admissions for children with chronic illness are related to medical controversy regarding the most appropriate treatment strategy, and approximately 33% are associated with medical dependency [23]. In general, parents of children with

Technologic devices for medically complex children

Hospitalists should be familiar with enterostomy tubes, tracheostomy, indwelling central venous catheters, noninvasive ventilatory support, and ventricular shunts in terms of indications, complications, and the hospital-based evaluation of these devices.

Future research agenda

Research on MCC as a subgroup of CSHCN is critical to study and improve the quality of care they currently receive. Challenges to studying this population include the enormous diversity of conditions and absolute small number of patients at a single hospital. One study that examined the impact of a pediatric hospitalist system for MCC (as defined by a positive response to the CSHCN screener, transfers from an intensive care unit or an All Payer Refined Diagnosis-Related Group of three or four

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