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Specialty services for children with special health care needs: supplement not supplant the medical home
  1. Robert J Graham
  1. Associate in Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Children’s Hospital Boston
  1. Robert J Graham, MD, Children’s Hospital Boston, Critical Care Med/Bader 629, 300 Longwood Avenue, Boston, MA 02115–5724, USA; Robert.Graham{at}

Statistics from

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 CSHCN46 as well as general inpatient7 8 and critical care services.912 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 “technology-assisted care” had a relative risk of 373.13 Paediatric and emergency medicine taskforces have combined to establish guidelines for optimal pre-hospital and emergency services for this at-risk population.14 15 The Neely Conference ‘Developing Research Criteria to Define Medical Necessity in Emergency Medical Services’ called for inclusion of patients with special healthcare needs as part of future research efforts.16

In this issue of Archives of …

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  • Competing interests: None.

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