Description

There has been a significant increase in the number of medically complex children over the past 15 years (Burns K, Casey P, Lyle R, et al. Increasing prevalence of medically complex children in US hospitals. Pediatrics 2010; 126;638-645). A hospital based medical home for children with complex health conditions has been suggested to provide benefits to the child, the hospital, and caregivers (Cohen E, Friedman J, Nicholas DB, et al. A home for medically complex children: the role of hospital programs. J Healthc Qual 2008;30(3):7-15). The majority of referrals to a recently established (two years) pediatric palliative care program in a children’s hospital involved coordination of care and symptom management for medically complex children: 69 of 114 (60%) in Year One and 77 of 144 (53%) in Year Two. Other referral categories were oncology, perinatal bereavement, pain management and end of life care. For children dependent on mechanical ventilation a program to educate caregivers in the use of ventilators at home was established. The palliative care team performs the outpatient care of these children. A medical home for medically complex children can be a major argument in proposals to establish hospital based pediatric palliative care programs.