{"doi":"10.1002/jhm.12948","title":"Admitting what is needed: How the health system and society can reduce hospitalizations for children with medical complexity","abstract":"Hospitalization is a relatively common occurrence for patients with medical complexity. In fact, high health care use is a defining feature of children with medical complexity (CMC).1 CMC are a heterogeneous and growing population, unified by conceptual similarities: multisystem and frequently progressive chronic conditions leading to substantial functional limitations, family-identified service needs, and high healthcare use.1 Annually, approximately 13%–20% of CMC are hospitalized2, 3 and 50%–80% of CMC healthcare spending goes to hospital care.1, 3, 4 However, some hospitalizations experienced by CMC are avoidable.5 Substantial variation in hospital utilization for CMC across regions,6 conditions,3 and emergency departments7 suggests opportunities surround us. Avoiding hospitalization for CMC is beneficial for most stakeholders. Fewer hospitalizations are in the interest of payers and aligned with those health systems engaged in risk-sharing or capitated arrangements for CMC populations. For families, hospital admissions are extremely challenging periods. In this study, we—a hospitalist, a parent of a child with medical complexity, and a complex care pediatrician—review causes of hospitalization and propose recommendations to reduce hospitalizations for CMC (Table 1). Identify clinical quality measures that are linked to hospitalization Design and test interventions with family partners that strengthen family capacity and address child susceptibility to serious acute illness Quantify and reduce inequities in access, retention, and benefits from complex care models for diverse populations Uncover active ingredients of complex care that lead to reductions in hospitalization and develop strategies to implement these activities in general outpatient settings Use conceptual models and include analyses of intervention mechanisms in research Evaluate the impact of policies to support family caregivers on hospitalization rates Advocate for policies that support care for children with medical complexity at home and in the community, including adequate quantities of supplies/equipment, respite, and reimbursement/workforce to reliably meet family needs Develop adaptive interventions that can respond to the dynamic, changing nature of child and family circumstances Establish an evidence base to treat common causes of acute illness or chronic disease exacerbation through rigorous clinical intervention research Clarify complex care's vision, for example, as a specialty service for those with medical complexity to access, or as a set of effective activities implemented broadly throughout redesigned pediatric care We might assume that the clinical needs intrinsic to medical complexity mean that clinical care drives CMC outcomes (such as hospitalization) to a greater extent than for general populations, where clinical care explains only 20% of population health.8 However, clinical care might, perhaps counterintuitively, play a similarly limited role in determining outcomes even for CMC. For example, common healthcare quality measures can have weak or limited relationships with hospitalization risk for CMC. Family-reported measures of ambulatory care access, experience, and process appear to poorly predict subsequent hospitalizations for CMC, even though several of these measures predict hospitalizations for children with less complex chronic illnesses.2 Ambulatory care sensitive conditions (ACSC, e.g., asthma, pneumonia, urinary tract infection) are generally considered manageable through high-quality outpatient care and therefore indicate potentially preventable hospitalization. However, research involving CMC with ACSC hospitalizations challenges this conceptualization. For example, ambulatory care measures may be poor predictors of ACSC hospitalizations for CMC despite predicting ACSC hospitalizations for children with noncomplex chronic illness.9 Receipt of outpatient care in the week prior to admission is similar for CMC whether admiss","journal":"Journal of Hospital Medicine","year":2022,"id":260098,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":16,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9609,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2022-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":913854,"name":"Danielle M. Gerber","orcid":null,"position":1,"is_corresponding":false},{"id":364339,"name":"Ryan J. Coller","orcid":"0000-0003-2657-294X","position":2,"is_corresponding":false},{"id":913229,"name":"Laura P. Chen","orcid":"0000-0001-5267-0565","position":0,"is_corresponding":true}],"reference_count":42,"raw_metadata":null,"created_at":"2026-07-19T00:26:03.189798Z","pmid":"35996947","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}