The Intersection of Complex Care and Hospital Medicine: Opportunities to Advance Health for Chronically Ill Populations

Children with medical complexity (CMC) are a high-need, high-cost population representing 1% of all children yet accounting for nearly one-third of all child health-related costs.1 Nearly half of health costs for CMC are attributable to hospital care2; 30-day readmission rates for CMC are 4 times higher than that for non-CMC,3 and 26% of hospital days and 43% of in-hospital deaths are attributable to CMC.4 High hospital use by CMC is a consequence of multiple chronic conditions, severe functional limitations, reliance on long-term medical technology for daily living (eg, feeding tube in a child with severe neurologic impairment), and high-intensity care needs supported by multispecialty care and home-based services (eg, home nursing) that are typical for this patient population.1 Parents of CMC take responsibility for the vast majority of caregiving and face many challenges, including inadequate insurance, lack of a patient-centered medical home, and insufficient hours of coverage for home health care workers.5 As a result of intense financial and emotional stress, caregivers themselves experience physical and mental health problems that can compromise their ability to effectively perform caregiving tasks.6 Additionally, direct clinical encounters for CMC in health care settings are often inefficient and poorly coordinated.5 Because the traditional health care delivery system often fails to meet the needs of CMC and their families, because CMC frequently receive acute hospital care, and because care of CMC is a core competency of pediatric hospital medicine (PHM), pediatric hospitalists have an essential role to play in the development of innovative solutions to improve care for CMC.7 In …