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Programs for Children with Complex Chronic Conditions at Brenner Childrens Hospital Savithri Nageswaran MD,MPH September 12 th 2012.

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Presentation on theme: "Programs for Children with Complex Chronic Conditions at Brenner Childrens Hospital Savithri Nageswaran MD,MPH September 12 th 2012."— Presentation transcript:

1 Programs for Children with Complex Chronic Conditions at Brenner Childrens Hospital Savithri Nageswaran MD,MPH September 12 th 2012

2 PEDIATRIC ENHANCED CARE PROGRAM Pediatric Enhanced Care Team (PECT) Community Pediatric Enhanced Care Team (CPECT) Community Pediatric Enhanced Care Team (CPECT-Extend) Collaborative Care Service

3 Medical Neighborhood: Healthy Child Medical Home Dentist Child & Family AHRQ White Paper: Medical Neighborhood

4 Medical Neighborhood: Child with a Chronic Condition Medical Home Specialist Dentist Pharmacy Child & Family AHRQ White Paper: Medical Neighborhood

5 Medical Neighborhood: Child with Complex Chronic Condition Medical Home Specialist 1 Specialist 2 Specialist 3Specialist 4 Specialist 5 Pharmacy Home Health DME Companies Inpatient Care Schools Family Support Child & Family AHRQ White Paper: Medical Neighborhood

6 Pediatric Enhanced Care Program PECT: pediatric palliative care in the hospital for seriously ill children – 1 FTE nurse & 0.3 FTE physician – Funding: Duke Endowment start-up funds; now Brenner Childrens Hospital CPECT: care coordination for children with CCC in Forsyth County – 0.5 FTE nurse, 0.05 FTE project director, 0.1 research associate – Funding: Maternal & Child Health Bureau CPECT-Extend: Extension of CPECT to Yadkin, Surry, Stokes, Davie, Wilkes counties – 0.75 social worker, 0.05 project director & 0.1 research associate – Funding: Maternal & Child Health Bureau Collaborative Care Service (CCS): collaboration between multiple sub- specialists in the care of children with undiagnosed complex conditions – 0.5 FTE nurse & 0.15 physician – Funding: Brenner Childrens Hospital

7 Children with CCC at Brenner Childrens Hospital (FY 2009 PECT Patient Statistics) days (All children in BCH 6.6) ALOS 40 days Average hospital days/ patient 179, 209, 216, 222, largest hospital days 3 Average # of Discharges/Patient 61.6% Percent of Patients with Multiple Discharges 7, 8, 9, 11, 13 5 largest number of discharges Medical Center Strategic Planning ; January 2010

8 Children with CCC at Brenner Childrens Hospital (FY 2009 PECT Patient Statistics) UtilizationPECT (%)* 3-Day Readmission Rate 6.9 % 7-Day Readmission Rate 11.9 % 14- Day Readmission Rate 21.1 % 30- Day Readmission Rate 35.6 % ED Visits within 7-days of Discharge 18 12% *Medical Center Strategic Planning ; January 2010

9 Children Enrolled in CPECT & CPECT/E (n=56) All <18 (one now older than 18) All chronic condition Complexity upon enrollment – >5 subspecialists/services 46 yes, 4 no, 2 missing – >2 technology 29 yes, 19 no, 4 missing – >3 hospitalization/months 14 yes, 34 no, 4 missing – >30 days hospitalized/6 months 20 yes, 28 no, 4 missing

10 Care Coordination Needs Factors that Determine Care Coordination Needs: Complexity of the condition Fragmentation of care Family capacity - AHRQ: Care Coordination Atlas 2011

11 Child & Family Medical Home Speciali st Dentist Pharmac y Care Coordination Needs: Complexity Medical Home Specialist 1 Specialist 2 Specialist 3Specialist 4 Specialist 5 Pharmacy Home Health DME Companies Inpatient Care Schools Family Support Child & Family

12 Care Coordination Needs: Low Fragmentation Medical Home Specialist 1 Specialist 2 Specialist 3Specialist 4 Specialist 5 Pharmacy Home Health DME Companies Inpatient Care Schools Family Support Child & Family

13 Care Coordination Needs: High Fragmentation Medical Home Specialist 1 Specialist 2 Specialist 3Specialist 4 Specialist 5 Pharmacy Home Health DME Companies Inpatient Care Schools Family Support Child & Family

14 Care Coordination Needs: Family Capacity

15 Care Coordinator's Contacts with Children with CCC & their Families

16 Care Coordination of Children with CCC

17 Gaps in Coordinated Care of Children with CCC

18 Community Team to Coordinate Care of Children with CCC

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23 PEDIATRIC ENHANCED CARE PROGRAM Pediatric Enhanced Care Team (PECT) Community Pediatric Enhanced Care Team (CPECT) Community Pediatric Enhanced Care Team (CPECT-Extend) Collaborative Care Service New: Interdisciplinary clinic for children with CCC


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