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Specialty services for children with special health care needs: supplement not supplant the medical home

Associate in Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital Boston

Correspondence to:
Robert J Graham, MD, Children’s Hospital Boston, Critical Care Med/Bader 629, 300 Longwood Avenue, Boston, MA 02115–5724, USA; Robert.Graham@childrens.harvard.edu

The first 150 words of the full text of this article appear below.

Children with special health care needs (CSHCN) are a large part of the population in developed countries throughout the world.¹ Definitions vary, and can encompass children with congenital, acquired and developmental behaviour conditions, degrees of chronicity, technology dependence, limitations in activity or care dependence, and other factors. The broadest prevalence estimates range as high as 18–44% of the general paediatric population.^{2 3} Complex medical needs and related vulnerabilities in this population might necessitate extensive home care and community services, frequent outpatient visits and use of acute care services. Unfortunately, there are cavernous voids in systematic care of CSHCN.

Several studies have demonstrated the extensive use of emergency services by CSHCN^4–6 as well as general inpatient^{7 8} and critical care services.^9–12 Dosa et al showed that children with any chronic health condition had a relative risk of 3.3 for unscheduled intensive-care admission versus compared with those without chronic illness. The subgroup with previous . . . [Full text of this article]