19 Paediatric complex care delivery models in Canadian tertiary care centers – A cross-sectional survey study of health care providers
Notice bibliographique
Résumé
Abstract Background While children with medical complexity (CMC) represent less than 1 % of the paediatric population, they account for one-third of healthcare expenditure. Based on previous literature and our patient care experience, CMC and their families have unmet care needs. Gaps in care highlighted in recent literature include poor integration of medical and community services, lack of support for emotional/behavioural challenges, lack of support for families/caregivers, and poor sustainability of care coordination efforts. In Canada, many different models are used depending on the center. Limited data is available on the most effective models of care for CMC patients. Objectives In this project, we aim to determine models of outpatient paediatric complex care delivery used in Canadian Tertiary care centers. Design/Methods We conducted a cross-sectional online survey of healthcare providers involved in paediatric complex care across Canada. Data collection took place from August 1 to October 4, 2024. The survey included a mix of open- and close-ended questions. Data collected included demographics, program structure, patient population, services and interventions, and outcomes and impact. Both qualitative and quantitative analyses were completed. Results We collected 19 complete responses from healthcare professionals (HCPs) across Canada, with representation from most tertiary care centers in Canada (11 centers). There are nine tertiary care centers in Canada with a complex care (CC) team. Most respondents were physicians (73.7%), followed by nurse practitioners (15.8%), nurses (5.3%), and social workers (5.3%). Among the 9 programs, the majority indicated their programs were co-management-centered (77.8%), while primary care (22.2%) and episodic models (33.3%) were less common. Among centers that have a CC program, 100% offered consultative services, 77.8% offered care coordination, 88.9% offered access to nurses/NPs during clinic hours, and 22.2% offered overnight on-call services. Home visits were offered by 44.4% of programs and 55.6% offered palliative care services. The majority of programs had social workers and nurses/nurse practitioners on the team. The most common conditions managed by these programs were complex/global developmental delays and technology dependence. Conclusion The majority of tertiary care centers in Canada have a dedicated outpatient multidisciplinary complex care program. Each program is unique in its structure and programming, however, most programs offer consultative care, care coordination, and daytime on-call services.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,006 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,002 | 0,007 |
| Études des sciences et des technologies | 0,006 | 0,001 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,002 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».