RT Book, Section
A1 Agrawal, Rishi
A1 Murphy, Nancy
A2 Zaoutis, Lisa B.
A2 Chiang, Vincent W.
SR Print(0)
ID 1146124514
T1 Introduction to the Child with Medical Complexity
T2 Comprehensive Pediatric Hospital Medicine, 2e
YR 2017
FD 2017
PB McGraw-Hill Education
PP New York, NY
SN 9780071829281
LK accesspediatrics.mhmedical.com/content.aspx?aid=1146124514
RD 2024/04/25
AB The  care  of  children  with  medical  complexity  (CMC)  is  an  increasingly  central  component  of  pediatric  hospital  medicine.  While  there  is  no  consensus  definition  for  this  population,  a  recent  conceptual  framework  posits  four  key  domains:  high  levels  of  family-identified  needs,  severe  chronic  conditions,  significant  functional  limitations,  and  elevated  health  resource  utilization.1  CMC  include  children  with  static  or  progressive  neurologic,  neuromuscular,  and  genetic  or  acquired  conditions  that  require  the  assistance  of  medical  technologies  such  as  gastrostomy  or  tracheostomy,  require  care  from  multiple  subspecialists  and  therapists,  and  have  significant  family-identified  needs  for  care  coordination  across  the  continuum  of  care.  For  example,  children  with  quadriplegic  cerebral  palsy,  muscular  dystrophies,  congenital  myopathies,  high  myelomeningoceles,  and  glycogen  storage  diseases  such  as  Morquio  syndrome  have  medical  complexities.  For  some  conditions  with  a  wide  variety  of  severity  of  manifestations,  a  subset  of  more  severely  affected  patients  would  be  considered  medically  complex.  For  instance,  a  child  with  sickle  cell  disease  with  multiple  comorbidities  (pulmonary  hypertension,  stroke,  etc.)  and/or  medical  fragility  (e.g.  frequent  hospitalizations  for  crises)  would  also  be  considered  medically  complex.  Health  services  researchers  use  a  variety  of  methods  to  identify  such  children  from  diagnostic  (ICD-9)  codes,  such  as  the  Complex  Chronic  Conditions,  3M  Clinical  Risk  Groups  (CRG),  and  Neurological  Impairment  codes.2-4  The  National  Survey  of  Children  with  Special  Health  Care  Needs  has  also  been  analyzed  in  a  way  to  identify  such  children  at  a  population  level,  suggesting  a  population  prevalence  of  0.4%.5