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February 21, 2011

Researchers focus on children with medical complexity to improve efficiencies in the health-care system

TORONTO – In Ontario, children with complex chronic conditions represent only one per cent of the paediatric population, but their impact on the health-care system is substantial, accounting for over 23 per cent of all child health-care spending.  Children with medical complexity are those who have many health problems, see several specialists, often need home care and are at risk of being continuously sick. Examples include, but are not limited to, children with complex cardiac disease, autism with severe behavioural concerns or cancer patients with ongoing challenges in multiple areas.

In a review led by The Hospital for Sick Children (SickKids), researchers developed a model that examines the needs, chronic conditions, functioning and health-care use of this population of children. They define a framework to improve health outcomes for, and potentially reduce the financial burden on the health-care system. The review was published in the Feb.21 online edition of Pediatrics

“Individually the conditions are often rare, but collectively they share common consequences such as larger health care needs, dependence on technology or home care to maintain quality of life, and a greater risk of frequent hospital visits,” says Dr. Eyal Cohen, lead author of this study, Paediatrician and Project Investigator at SickKids. “The medical fragility and intensive care needs of these children are not easily met by existing health-care models.”

Health-care delivery for children has changed and continues to evolve – particularly in hospitals.  Because of medical advances and improved treatments, the survival rates of premature babies and those born with life-threatening conditions have increased. These medical successes have likely resulted in a rise of chronic conditions and childhood disability. While paediatric hospitals in the past primarily dealt with isolated health problems, today hospitals care for children with more complex diseases that have an enormous impact on the child, family and community.  

In fact, in a study published in the Feb.16 edition of the Journal of the American Medical Association, theauthors (including Cohen) found that a large portion of costs at children’s hospitals are accounted for by frequent readmissions. The most common patients who are frequently readmitted are children with complex chronic conditions such as those with cerebral palsy.

“The fact that this group of kids keep coming back suggests that more planning of discharge care is needed to ensure a safe transition from the hospital,” explains Cohen, who is also Assistant Professor at the University of Toronto. “Without better coordination and access to services and outpatient service providers, readmission may be unavoidable for these patients because the health-care system is not meeting all of the patient and family's needs.”

The framework referred to in the Pediatrics review suggests a family-centred system of care that encourages self-management by improving accessibility of services and information. 

According to Cohen, improved quality of care for children with medical complexity depends on better integration of patient care between the hospital and the community. “This would mean establishing strong links between the tertiary care facility and health-care services such as rehabilitation centres, schools, transitional care and other facilities in a community-based setting,” he says.

This review was supported by the Norman Saunders Complex Care Initiative at SickKids and SickKids Foundation. 

About The Hospital for Sick Children
The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally.  Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system.  SickKids is proud of its vision of Healthier Children. A Better World.™ For more information, please visit www.sickkids.ca. 

About Peter Gilgan Centre for Research and Learning 
The Peter Gilgan Centre for Research and Learning will bring together researchers from different scientific disciplines and a variety of clinical perspectives, to accelerate discoveries, new knowledge and their application to child health — a different concept from traditional research building designs. The facility will physically connect SickKids science, discovery and learning activities to its clinical operations. Designed by award-winning architects Diamond Schmitt Architects Inc. and HDR Inc. with a goal to achieve LEED® Gold Certification for sustainable design, the Gilgan Centre will create an architectural landmark as the eastern gateway to Toronto’s Discovery District. The Peter Gilgan Centre for Research and Learning is funded by a grant from the Canada Foundation for Innovation, the Government of Ontario, philanthropist Peter Gilgan and community support for the ongoing fundraising campaign. For more information, please visit www.sickkidsfoundation.com/bepartofit.

For more information, please contact:

Matet Nebres
The Hospital for Sick Children
Phone: 416-813-6380
email: matet.nebres@sickkids.ca

Caitlin McNamee-Lamb
The Hospital for Sick Children
Phone: 416-813-7654 ext. 1436
email: caitlin.mcnamee-lamb@sickkids.ca