Collaborative Model of Care Between Primary Care and Inpatient Management for Children with Medical Complexity
2021 Summit

Collaborative Model of Care Between Primary Care and Inpatient Management for Children with Medical Complexity

October 2021

Presented by Adam Rosenbloom, MD MPH - Pediatrician - Ascension Medical Group and Rahel Berhane, MD - Medical Director, Children's Comprehensive Care Clinic - Ascension Health

Speakers:

Adam Rosenbloom, MD MPH – Pediatrician – Ascension Medical Group

Rahel Berhane, MD – Medical Director, Children's Comprehensive Care Clinic – Ascension Health

Children with medical complexity (CMC) constitute pediatric patients with multiple, significant health problems affecting multiple organ systems and resulting in functional limitations with increased health care needs or utilization. Hospital courses are often complicated and require significant resources. The Comprehensive Care Clinic (CCC) is a dedicated, multidisciplinary, medical home for CMC. This session will review the unique challenges posed in caring for CMC in the inpatient setting. We will present our collaborative approach between the CCC and a devoted inpatient team to caring for CMC. We will explore our effective care coordination model across the continuum from hospital to home. Outcomes of this intervention included average length of stay, and readmission rates. This session will discuss the lessons learned from iterating on this model over multiple PDSA cycles.

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Presented by Adam Rosenbloom, MD MPH - Pediatrician - Ascension Medical Group and Rahel Berhane, MD - Medical Director, Children's Comprehensive Care Clinic - Ascension Health
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