Search for a command to run...
<h3>Objectives</h3> A local Child Health Team (CHT), comprising Lead GP for children, Paediatrician, and Paediatric nurse delivers integrated care, as part of the CHILDS model (Child Health Integrated Learning and Delivery System, developed by the Children and Young People’s Health Partnership, CYPHP). All non-urgent referrals and clinical queries from primary, community, or hospital staff are triaged by the CHT. Triage outcomes include advice, care in a local child health clinic, or referral. The aim of this study is to determine the impact of CHT triage of children, using a service evaluation. <h3>Methods</h3> We examined CHT triage and clinic activity, GP, and hospital outpatient activity, for a 3-month period in 2022/23 with the same period a year earlier, to investigate the impact as this aspect of the service became embedded. We also investigated health service use in the 6 months before and after triage. We used primary and secondary care data linked using a unique pseudo-NHS number. We constructed a negative binomial model, based on a Poisson distribution, adding an additional parameter to account for over-dispersion of the count data, using Huber robust variances to compensate for the clustered nature of the data (repeat observations from the same child). <h3>Results</h3> Comparing a three-month period in 2022/23 with the same three-month period a year earlier, we demonstrated a reduction in new referrals for hospital outpatient appointments by 34%; and a 17% reduction in the total number of children seen in hospital outpatients and local child health clinics combined (figure 1). Examining health service use 6 months after triage shows significant reductions in all measures (table 1): 60% reduction in non-elective hospital admissions, 22% reduction in emergency department contacts, 23% reduction in outpatient appointments, and 32% reduction in GP appointments with a marked increase in the number of children who had zero GP appointments in the 6-month period after triage (not shown). <h3>Conclusions</h3> The triage component of the new CHILDS integrated care model appears to have had a significant impact on hospital outpatient attendances, GP attendances, and local child health clinics, as assessed using a service evaluation design with before-after service use analyses. Feedback suggests that the system is well liked and valued by GPs and families: the local child health team is considered accessible and responsive. An interrupted time series analysis is forthcoming. The wider results of the pragmatic cluster randomised control trial is currently under review for publication. https://childsframework.org <h3>Reference</h3> Wolfe I, <i>et al</i>. A pragmatic cluster randomised controlled trial (cRCT) to assess child health service use, child health outcomes, and parental wellbeing: the Children and Young People’s Health Partnership (CYPHP) model of paediatric integrated care. Under review.