Primary Author: Van D. Truong, MD
Contributing Author/Faculty Mentor: Christine Murphy, MD, FAAP
Objective: Our aim for this study was to survey UTMB pediatric residents to identify the prevalence of selected barriers that may affect the care of CMC and determine if there is an association between post-graduate year (PGY) and these barriers of care. Our secondary aim was to find what interventions were believed to be most helpful for residents when caring for CMC.
POSTER ABSTRACT (View Poster PDF)
Background: Children with medical complexity (CMC) are defined as individuals with: (1) substantial family-identified health care services needs with significant impact on the family unit; (2) chronic or severe clinical conditions that are associated with medical fragility; (3) functional limitations that may require technology (e.g. gastrostomy tube, wheelchair); and/or (4) high healthcare resource utilization (e.g. multiple subspecialty providers). There is a need to improve the coordination of care of CMC as their population increases due to increasing survival rates of premature infants and those with chronic conditions. Several barriers affect our care of these patients including: medical, non-medical, practice and institution barriers.
Methods: A sample of 29 UTMB pediatric residents from all three post graduate years was surveyed using a previously validated questionnaire. Participants were surveyed over whether selected medical, non-medical, practice, and institutional barriers affected the care of their CMC patients. Participants were also surveyed on interventions that could help these patients.
Results: There was no statistically significant association between post-graduate year and any of the surveyed barriers. There was a statistically significant association between post-graduate year and perception of the helpfulness of a “single comprehensive medical record.”
Conclusions: One of the most prevalent barriers identified was unclear goals of medical care. In addition, the most prevalent interventions were facilitation of group meetings with physicians and access to summative action plan. This study demonstrated positive pediatric resident perception of the importance of a summative care plan, which would both clarify the goals of medical care for CMC and help facilitate communication amongst providers.
References:
1. Quigley, Laura et al. “A Qualitative Analysis of Information Sharing for Children with Medical Complexity Within and Across Health Care Organizations.” BMC Health Services Research 14.1 (2014): 283. Web.
2. Foster, Carolyn C, Rita Mangione-Smith, and Tamara D Simon. “Caring for Children with Medical Complexity: Perspectives of Primary Care Providers.” The Journal of Pediatrics 182 (2017): 275–282.e4. Web.