title: Health Services and Health Care Needs Fulfilled by Structured Clinical Programs for Children with Medical Complexity.
abstract: OBJECTIVE
  To describe family-reported health service needs of children with medical complexity (CMC) and to assess which needs are more often addressed in a tertiary care center-based structured clinical program for CMC.
  
  
  METHODS
  Mailed survey to families of CMC enrolled in a structured-care program providing care coordination and oversight at 1 of 3 children's hospitals. Outcomes included receipt of 14 specific health service needs. Paired t tests compared unmet health care needs prior to and following program enrollment.
  
  
  RESULTS
  Four hundred forty-one of 968 (46%) surveys were returned and analyzed. Respondents reported their children had a mean age of 7 (SD 5) years. A majority of respondents reported the child had developmental delay (79%) and feeding difficulties (64%). Of the respondents, 56% regarded the primary care provider as the primary point of contact for medical issues. Respondents reported an increase in meeting all 14 health services needs after enrollment in a tertiary care center-based structured clinical program, including primary care checkups (82% vs 96%), therapies (78% vs 91%), mental health care (34% vs 58%), respite care (56% vs 75%), and referrals (51% vs 83%) (all P < .001).
  
  
  CONCLUSIONS
  Tertiary care center-based structured clinical care programs for CMC may address and fulfill a broad range of health service needs that are not met in the primary care setting.
authors.affiliation: Center for Applied Research and Evaluation, Arkansas Children's Hospital, University of Arkansas for Medical Sciences, Little Rock, AR; Arkansas Children's Hospital Research Institute, Little Rock, AR. Electronic address: dzkuo@uams.edu.
authors.forename: Dennis Z
authors.initials: DZ
authors.lastname: Kuo
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Jay G
authors.initials: JG
authors.lastname: Berry
authors.affiliation: Division of General Pediatrics, Department of Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Laurie
authors.initials: L
authors.lastname: Glader
authors.affiliation: Institute of Medicine, Washington, DC.
authors.forename: Melinda J
authors.initials: MJ
authors.lastname: Morin
authors.affiliation: Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: Sarah
authors.initials: S
authors.lastname: Johaningsmeir
authors.affiliation: Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
authors.forename: John
authors.initials: J
authors.lastname: Gordon
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services / Q000458:organization & administration*; D002675:Child, Preschool; D002658:Developmental Disabilities / Q000453:epidemiology; D019988:Children with Disabilities / Q000706:statistics & numerical data*; D005260:Female; D006301:Health Services Needs and Demand / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011795:Surveys and Questionnaires; D062606:Tertiary Care Centers / Q000458:organization & administration*