Quality Improvement Strategies for Population Management of Children With Medical Complexity

Pediatrics. 2017 Sep;140(3):e20170484. doi: 10.1542/peds.2017-0484.


Background and objectives: Children with medical complexity require the expertise of specialists and hospitals but may lack primary care to provide preventive, acute, and chronic care management. The Complex Care Center (CCC) at Cincinnati Children's Hospital Medical Center employed quality improvement methodologies in 3 initiatives to improve care for this fragile population.

Methods: Improvement activities focused on 3 main areas: population identification and stratification for care support, reliable delivery of preventive and chronic care, and planned care to identify and coordinate needed services.

Results: The percent of patients who attended a well-child care visit in the previous 13 months increased 91% and was sustained for the next year. The median monthly no-show rate remained unchanged. Within 10 months of implementing the interventions, >90% of CCC patients <7 years of age were receiving all recommended vaccines. Seventy-two percent of all CCC patients received their annual influenza vaccine. A sustained 98% to 100% of children with a complex chronic disease received previsit planning (PVP) for their well-child care and chronic condition management visits, whereas only 1 new patient did not receive PVP.

Conclusions: Children with medical complexity require adaptations to typical primary care processes to support preventive health practices, chronic and acute care management, immunization, and collaborative care with their multiple specialists and support providers. We used quality improvement methodology to identify patients with the highest needs, reliably deliver appropriate preventive and chronic care, and implement PVP.

MeSH terms

  • Child
  • Delivery of Health Care, Integrated / standards
  • Humans
  • Immunization
  • Multiple Chronic Conditions / therapy*
  • Patient Care Planning
  • Primary Health Care / methods
  • Primary Health Care / standards*
  • Primary Prevention
  • Quality Improvement*