19 Paediatric complex care delivery models in Canadian tertiary care centers – A cross-sectional survey study of health care providers
Bibliographic record
Abstract
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.
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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 | 0.003 | 0.006 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.002 | 0.007 |
| Science and technology studies | 0.006 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.002 | 0.002 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 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".