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

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