Programs for Children with Complex Chronic Conditions at Brenner

Children’s HospitalSavithri Nageswaran MD,MPH

September 12th 2012

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

Medical Neighborhood:Healthy Child

Child & Family

AHRQ White Paper: Medical Neighborhood

Medical Neighborhood:Child with a Chronic Condition

Child & Family

AHRQ White Paper: Medical Neighborhood

Medical Neighborhood:Child with Complex Chronic Condition

Child & Family

AHRQ White Paper: Medical Neighborhood

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 Children’s

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 Children’s Hospital

Children with CCC at Brenner Children’s Hospital(FY 2009 PECT Patient Statistics)

Medical Center Strategic Planning; January 2010

Children with CCC at Brenner Children’s Hospital(FY 2009 PECT Patient Statistics)

Utilization PECT (%)*3-Day Readmission Rate 6.9 %

7-Day Readmission Rate 11.9 %

14- Day Readmission Rate 21.1 %

30- Day Readmission Rate35.6 %

ED Visits within 7-days of Discharge

1812%

*Medical Center Strategic Planning; January 2010

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

Care Coordination Needs

Child & Family

Medical Home

Specialist

Dentist

Pharmacy

Care Coordination Needs:Complexity

Child & Family

Care Coordination Needs:Low Fragmentation

Child & Family

Care Coordination Needs:High Fragmentation

Child & Family

Care Coordination Needs: Family Capacity

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

Care Coordination of Children with CCC

Gaps in Coordinated Care of Children with CCC

Community Team to Coordinate Care of Children with CCC

Community Team to Coordinate Care of Children with CCC

Community Team to Coordinate Care of Children with CCC

Community Team to Coordinate Care of Children with CCC

Community Team to Coordinate Care of Children with CCC

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