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Population child health: understanding and addressing complex health needs
  1. Katelyn Aitchison1,
  2. Helen McGeown2,
  3. Ben Holden1,
  4. Mando Watson1,
  5. Robert Edward Klaber1,
  6. Dougal Hargreaves3
  1. 1 Department of Paediatrics, Imperial College Healthcare NHS Trust, London, UK
  2. 2 University of Bristol Centre for Academic Primary Care, Bristol, UK
  3. 3 Department of Primary Care and Public Health, Imperial College London, London, UK
  1. Correspondence to Dr Katelyn Aitchison, Imperial College Healthcare NHS Trust, London W2 1NY, UK; katelyn.aitchison{at}


Advances in paediatric care mean that more children with complex medical problems (heart disease, neurodevelopmental problems and so on) are surviving their early years. This has important implications for the design and delivery of healthcare given their extensive multidisciplinary requirements and susceptibility to poor outcomes when not optimally managed. Importantly, their medical needs must also be understood and addressed within the context of the child and family’s life circumstances. There is growing recognition that many other factors contribute to a child’s complex health needs (CHNs), for example, family problems, fragmentation of health and care provision, psychological difficulties or social issues.

To facilitate proactive care for these patients, we must develop accurate ways to identify them. Whole Systems Integrated Care—an online platform that integrates routinely collected data from primary and secondary care—offers an example of how to do this. An algorithm applied to this data identifies children with CHNs from the entire patient population. When tested in a large inner-city GP practice, this analysis shows good concordance with clinical opinion and identifies complex children in the population to a much higher proportion than expected. Ongoing refinement of these data-driven processes will allow accurate quantification and identification of need in local populations, thus aiding the development of tailored services.

  • general paediatrics
  • comm child health
  • health service
  • health services research

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  • Twitter @DrBenHolden, @mandowatson, @bobklaber

  • Contributors REK, HM and BH developed the WSIC logic sequence. MW and KA tested the logic in the GP practice setting. KA, REK and DH discussed the initial plan for this article. KA wrote the initial draft. This was reviewed and edited by the remaining coauthors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Disclaimer The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

  • Competing interests REK is an associate editor for BMJ Leader.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.

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