Improving Care for Children With Complex Needs
Condition: Medically Complex Children; Care Coordination; Case Manager; Care Manager; Collaborative Care; Disease Management; Patient Care Team or Organization; Managed Care; Children With Chronic Conditions; Children With Special Health Care Needs; Shared Care Plan; Patient Care Plan; Health Care and Resource Utilization; Adherence to Care; Functional Status and Productivity; Health Related Quality of Life; Satisfaction With Care; Care Coordinator; Family Experience of Care; Quality Health Care
MeSH terms: Chronic Disease
Study type: Interventional

Summary: 
      Seattle Children's Hospital (SCH), in collaboration with several health plans and Washington
      State Department of Social and Health Services developed the Comprehensive Case Management
      (CCM) program with the goal to reduce costs of care for medically complex children cared for
      at SCH as well as improve their health status and the quality of care they receive. The CCM
      program aims to develop and facilitate a reliable and standardized process that empowers the
      child's primary care provider and provides him/her with the resources s/he needs to avoid
      unnecessary emergency department visits and admissions. Our study will include children who
      had a hospitalization or emergency department visit at Seattle Children's between 2009-2012
      and, at that time, had multiple active chronic medical issues but had no specialty service at
      Seattle Children's to help their primary care providers manage them.
    

Detailed description: 
      Children with complex health care needs often lack a comprehensive care plan and access to
      case management. They are at risk for frequent and prolonged hospitalizations, fragmented
      care, parental stress/burnout and unsafe care. To address this issue, Seattle Children's
      Hospital developed the Comprehensive Case Management (CCM) program, which includes access to
      a special clinic at Seattle Children's with case managers and a health care team that works
      with parents and community physicians to create care plans for children with complex needs.

      The investigators goal is to evaluate whether children who participate in the CCM program
      have better parent reported access to needed care, timeliness of receiving needed services,
      more coordinated care, improved health status, and higher parent satisfaction with care
      compared to children who receive care outside the CCM program. In addition, the investigators
      will examine whether these children experience decreased annual costs of care, emergency
      department visits, hospital admissions, and hospital lengths of stay compared to children
      receiving care outside the program. The investigators also want to understand whether
      community physicians who have patients enrolled in the CCM program are more satisfied with
      caring for children with complex medical needs than physicians caring for these children
      outside the program.

      The investigators plan to enroll 650 parents of eligible children into the I3CN study. Three
      hundred twenty five of these parents will have children enrolled in the CCM program and 325
      will have children who continue to receive usual care. Enrolled parents complete a survey
      every 6 months during the study (5 surveys over 2 ½ years) in order to assess study outcomes
      including parent perceived. Parent participation in the study will be completed 2 ½ years
      after enrollment.

      When a child enrolls in the CCM program, the child's parent will work together with the CCM
      team at Seattle Children's to develop a shared care plan for their child. The CCM team
      includes physicians, nurse practitioners, social workers, nutritionists, and nurse case
      managers. This plan will include all of the child's routine health care needs in addition to
      information about what to do when the child gets sick. Community providers will also be asked
      to review and provide input on the shared care plan. Once the shared care plan is in place,
      the parent, primary care provider (PCP), and the CCM clinic will follow the standardized
      processes established by the program and the shared care plan when the child becomes ill.

      During the course of the 2 ½ year study, the investigators will analyze our outcomes of
      interest every 6 months. If the investigators find that children in the CCM the program are
      experiencing significantly better outcomes than children receiving care outside the program,
      they will stop the study and open the program to all eligible children.
    

Intervention name(s): Comprehensive Case Management Service
Intervention type(s): Behavioral
Intervention description(s): When a child enrolls in the CCM program, the child's parent will work together with the CCM team at Seattle Children's to develop a shared care plan for their child. This plan will include all of the child's routine health care needs and information about what to do when the child gets sick. The parent will also have 24 hour access to an on-call CCM nurse.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Health Services Research