30: Impact of Implementing a Complex Care Program
Bibliographic record
Abstract
The Complex Care Program (CCP) evolved from the acknowledgement that the health care system for technology dependent medically complex, fragile children and youth across the region was fragmented, with multiple organizations working in silos in order to provide care for these complex patients. To improve upon this reality, a partnership was developed between the hospital and community partner organizations working together to better serve the needs of these complex patients. The goals of the CCP are to provide care coordination in a family-centered approach; to facilitate communication and collaboration among care providers; to maximize the days out of hospital and improve healthcare system utilization; with the overall objective of improving the health status of those impacted. An outcome evaluation based on participatory evaluation and hospital utilization data was performed. The evaluation framework focused on implementation and effectiveness of the CCP since its inception in 2010 and specifically evaluated four domains: accessibility of the program, health service utilization, health outcomes and impact, and acceptability of the program. The findings of the evaluation confirmed that patients (n=33) enrolled in CCP met criteria for medical complexity, fragility and technology dependency, while it also demonstrated favorable trends and good family and stakeholder satisfaction with the program. To investigate health service utilization changes, a series of paired-sample t tests of 12 months pre versus 12 months post program initiation were performed for 19 patients. Table 1 summarizes the analysis and demonstrates a statistically significant decrease (P value 0.049) in hospital days, from 20 to seven days over one year. This resulted in over ¾ of a million in savings based on a case-costing analysis. The CCP was successful in increasing efficiency in healthcare utilization, improving health care costs, while providing service coordination that is satisfactory to the families and the stakeholders involved. These trends also show a move towards providing care in the most appropriate setting from expensive inpatient treatment to more outpatient-based treatment.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.013 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.005 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".