title: Caring for Children with Medical Complexity: Perspectives of Primary Care Providers.
abstract: To describe typical care experiences and key barriers and facilitators to caring for children with medical complexity (CMC) from the perspective of community primary care providers (PCPs).
  
  
  
  PCPs participating in a randomized controlled trial of a care-coordination intervention for CMC were sent a 1-time cross-sectional survey that asked PCPs to (1) describe their experiences with caring for CMC; (2) identify key barriers affecting their ability to care for CMC; and (3) prioritize facilitators enhancing their ability to provide care coordination for CMC. PCP and practice demographics also were collected.
  
  
  
  One hundred thirteen of 155 PCPs sent the survey responded fully (completion rate = 73%). PCPs endorsed that medical characteristics such as polypharmacy (88%), multiorgan system involvement (84%), and rare/unfamiliar diagnoses (83%) negatively affected care. Caregivers with high needs (88%), limited time with patients and caregivers (81%), and having a large number of specialists involved in care (79%) were also frequently cited. Most commonly endorsed strategies to improve care coordination included more time with patients/caregivers (84%), summative action plans (83%), and facilitated communication (eg, e-mail, phone meetings) with specialists (83%).
  
  
  
  Community PCPs prioritized more time with patients and their families, better communication with specialists, and summative action plans to improve care coordination for this vulnerable population. Although this study evaluated perceptions rather than actual performance, it provides insights to improve understanding of which barriers and facilitators ideally might be targeted first for care delivery redesign.
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, WA; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA.
authors.forename: Carolyn C
authors.initials: CC
authors.lastname: Foster
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, WA; Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA.
authors.forename: Rita
authors.initials: R
authors.lastname: Mangione-Smith
authors.affiliation: Department of Pediatrics, University of Washington, Seattle, WA; Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA.
authors.forename: Tamara D
authors.initials: TD
authors.lastname: Simon
mesh_terms: D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000628:therapy*; D003430:Cross-Sectional Studies; D019988:Children with Disabilities; D005260:Female; D006801:Humans; D008297:Male; D010348:Patient Care Team / Q000458:organization & administration; D010817:Physician-Patient Relations; D058007:Physicians, Primary Care / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D011787:Quality of Health Care; D018570:Risk Assessment; D016896:Treatment Outcome; D035862:Vulnerable Populations
keywords: care coordination; care plan; children with special health care needs; medical complexity; quality improvement