Integrated care for children and young people with special health and care needs: a systematic review

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The review protocol was developed according to PRISMA-P guidance and registered in PROSPERO (CRD42020209320).

“The protocol was developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Protocol (PRISMA-P) guidance17 and was registered in PROSPERO: CRD42020209320.”

• cites [17] sourcePartly supported

  The Scope of the guideline section identifies PRISMA-P 2015 as a separate statement for reporting systematic-review protocols and says PRISMA 2020 is not intended for that purpose. It does not establish that the citing authors developed their protocol according to PRISMA-P. The PROSPERO registration is reported by the citing authors, not supported by this source. (LLM, conf=0.83)

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

Children with special health and care needs (CSHCN) have a broad scope and variety of complex needs.

“Children with special health and care needs (CSHCN) have a broad scope and variety of complex needs”

• Also stated in: § Introduction · plain

  “Children with special health and care needs (CSHCN), including chronic conditions, medical complexity and disability, have high levels of needs and rely on a range of services across sectors.1”

• cites [1] Dreyer K , Parry W , Jayatunga W , et al . A descriptive analysis of health care use by high-cost, high-need patients in England. PLoS ONE 2019;14. doi:10.1371/journal.pone.0217353 sourcePartly supported

  The Discussion and implications section describes high-need, high-cost patients as a heterogeneous group with multiple comorbidities, supporting the general point that their needs vary and can be complex. The study includes all age groups but does not specifically describe children with special health and care needs (CSHCN), so it does not establish the claim for that population. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

A systematic review exploring evidence exclusively on the role of a care coordinator for CSHCN highlighted the need for further evidence evaluating the role of care coordinators.

“This is also echoed through the findings of a systematic review35 exploring evidence exclusively on the role of a care coordinator for CSHCN which highlighted the need for further evidence evaluating the role of care coordinators.”

• cites [35] Hillis, 2016, The role of care coordinator for children with complex care needs: a systematic review, Int J Integr Care sourceSupported

May combine two claims.

Integrating care can be intensive and costly, sometimes with no measurable improvement in child functional status or hospital-based utilisation.

“First, that integrating care can be intensive and costly, sometimes with no measurable improvement in child functional status or hospital-based utilisation.29 37 38”

• cites [29] Simon TD , Whitlock KB , Haaland W , et al . Effectiveness of a comprehensive case management service for children with medical complexity. Pediatrics 2017;140. doi:10.1542/peds.2017-1641 sourceNot checked — no full text of the source
• cites [37] sourcePartly supported

  The Discussion describes care coordination interventions as intensive, supporting that part of the claim. But the costs measured are costs of caring for children with medical complexity, not the cost of integrating care. The study did not measure functional status or evaluate whether integration failed to improve hospital use; the Discussion instead says observational studies suggest coordination may reduce acute-care use. (LLM, conf=0.83)

  Experimental — accuracy not yet measured
• cites [38] sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

There were 10 studies in which the chronic condition involved multiple disorders ranging from motor, mental, behavioural or emotional to neurodevelopmental conditions.

“There were 10 studies in which the chronic condition involved multiple disorders ranging from motor, mental, behavioural or emotional to neurodevelopmental conditions,2029”

Probably not a substantial claim: may not pass S3 (load-bearing).

The ages of study participants varied between 0 and 25 years.

“the ages of study participants varied between 0 and 25 years.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A total of 145 studies were finally included and categorised by type of intervention.

“Hence, a total of 145 studies were finally included which were then categorised by type of intervention.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The search generated 18,985 articles eligible for title and abstract review.

“The search generated 18 985 articles which were eligible for review of title and abstract (figure 2).”

May combine two claims.

One study each was about children with type 1 diabetes and type 2 diabetes, medically fragile infants, behaviour problems with comorbid ADHD, and traumatic brain injury.

“and one study each about children with type 1 diabetes (T1D) and type 2 diabetes (T2D),30 medically fragile infants,31 behaviour problems with comorbid Attention Deficit Hyperactivity Disorder (ADHD)32 and traumatic brain injury (TBI).33”

May combine two claims.

For parent/carer perception on child health and family well-being, improvements were reported for all outcomes and statistical significance was achieved in only one study for child's psychosocial quality of life.

“Similarly, for outcomes under the parent/carer perception on child health and family well-being category, improvements were reported for all outcomes20 23 25 28 and statistical significance was achieved in only one study32 for child’s psychosocial quality of life (QoL).”

May combine two claims.

Within healthcare use and spend, two studies showed reduction in hospitalisation rate, although it was significant only in Coller et al. (adjusted incident rate ratio: 0.61; 95% CI 0.38-0.97; p=0.04).

“Within the healthcare use and spend category, two studies showed reduction in hospitalisation rate,22 27 although it was significant only in Coller et al. (adjusted incident rate ratio: 0.61; 95% (CI) 0.38–0.97; p=0.04)).22”

May combine two claims.

Within the child health and functioning category, improvement was seen in all outcomes; however, significant improvement was reported only by Braga et al for both motor and cognitive outcomes.

“Within the child health and functioning category, improvement was seen in all outcomes23 25 26 29 31; however, significant improvement was reported only by Braga et al33 for both motor and cognitive outcomes, respectively.”

May combine two claims.

For hospital admissions, one study reported reduction and the other reported slight increase (both p>0.05).

“Whereas for hospital admissions, one study reported reduction25 and the other reported slight increase29 (for both studies p>0.05).”

May combine two claims.

For total charges associated with patients, one study showed significant reduction (p=0.02) in the intervention group, one study reported reduction in both intervention and control groups (p=0.99), and one study reported lower costs for the control group (p=0.90).

“In terms of total charges associated with patients, one study showed significant reduction (p=0.02)22 in the intervention group, one study reported reduction in both the intervention and control groups (p=0.99),27 and one study reported lower costs for the control group (p=0.90).25”

May combine two claims.

Nearly all studies (n=12), regardless of the WHO's type of integrated care model, reported benefits of integrated care, with 8 studies reporting significant positive impacts on outcomes.

“Nearly all studies (n=12), regardless of the WHO’s type of integrated care model they represent,11 reported benefits of integrated care, with 8 studies reporting significant positive impacts on outcomes.2122 24 2933”

• cites [11] WHO . Integrated care models: an overview. WHO Regional Office for Europe Copenhagen, 2016.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

Seven studies reported on care coordination as either a primary or secondary outcome; however, they used different measures contributing to the 'very low' certainty of evidence.

“For instance, seven studies reported on care coordination212325 30 31 as either a primary or secondary outcome; however, they used different measures contributing to the ‘very low’ certainty of evidence.”

May combine two claims.

Only Bruns et al did not report any improvement for CSHCN using wrap-around care facilitators, and Simon et al reported higher hospitalisation admissions and costs in the group receiving the intervention.

“Only Bruns et al26 did not report any improvement for CSHCN using wrap-around care facilitators, and Simon et al29 reported higher hospitalisation admissions and costs in the group receiving the intervention.”

May combine two claims.

There was a lack of consistent tools used among the four categories of outcomes as all outcomes were measured using a unique instrument except for parent's perception on child's QoL reported by four studies, of which three used the same instrument (PedsQL) and one used KIDSCREEN-52.

“In addition, there was a lack of consistent tools used among the four categories of outcomes as all outcomes were measured using a unique instrument except for parent’s perception on child’s QoL reported by four studies,20 25 28 32 of which three used the same instrument (Pediatric Quality of Life—PedsQL)20 28 32 and one used KIDSCREEN-52.25”

May combine two claims.

In this review, seven studies exclusively described the role of a designated person in charge of care coordination, of which three reported significant improvement in care coordination, child health and functioning and a positive trend in healthcare use and spend (although not statistically significant).

“In this research, seven studies21 23 25 27 28 30 32 exclusively described the role of a designated person in charge of care coordination, of which three reported significant improvement in care coordination,21 23 30 child health and functioning32 and a positive trend in healthcare use and spend27 (although not statistically significant).”

May combine two claims.

For care coordination, the studies by Carcone et al, Gillette et al, and Jessop and Stein reported a significant improvement (p<0.05), whereas Farmer et al reported a strong trend (p=0.058) towards improved ratings of 'satisfaction with care coordination'.

“For care coordination, the studies by Carcone et al,30 Gillette et al,31 and Jessop and Stein24 reported a significant improvement (p<0.05), whereas the study by Farmer et al23 reported a strong trend (p=0.058) towards improved ratings of ‘satisfaction with care coordination’.”

May combine two claims.

There is a lack of evidence about integrated care for CSHCN given the heterogeneity and broad scope of complex medical and non-medical needs among CSHCN.

“Given the heterogeneity and broad scope of complex medical and non-medical needs among CSHCN, it is perhaps not surprising that there is a lack of evidence about integrated care.”

Classified as probably not a substantial claim. May combine two claims.

Two authors independently assessed risk of bias for each study using the Cochrane risk-of-bias assessment tool and evidence certainty using GRADE criteria.

“Two authors (SG and RH) independently assessed the risk of bias for each study using the Cochrane risk-of-bias assessment tool18 and evidence certainty using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria.19”

• cites [18] Higgins JPT , Savović J , Page MJ , et al . Assessing risk of bias in a randomized trial. In: Higgins JPT , Thomas J , Chandler J , et al , eds. Cochrane handbook for systematic reviews of interventions version 60. 2019. sourceNot checked — no full text of the source
• cites [19] GRADE Working Group . Grading of recommendations assessment, development and evaluation (GRADE), 2019. Available: http://www.gradeworkinggroup.orgNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The number of participants in intervention and comparison groups were usually balanced in number and by gender.

“The number of participants in intervention and comparison groups were usually balanced in number and by gender”

May combine two claims.

This could be attributed to the stark lack of high-quality evidence and absence of a minimum set of standardised outcomes which could be generalised across populations of CSHCN.

“This could be attributed to the stark lack of high-quality evidence and absence of a minimum set of standardised outcomes which could be generalised across populations of CSHCN.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Inadequately described interventions meant that some assumptions had to be made.

“Furthermore, inadequately described interventions meant that some assumptions had to be made.”

• AssumptionThe authors state this as an assumption: Improvements in outcomes related to child health, parent's perception or satisfaction, or healthcare use in studies not reporting care coordination could result from better care coordination.

Probably not a substantial claim: may not pass S3 (load-bearing).

Previous research has emphasised the importance of care coordination as well as continuity of care through a designated or dedicated personnel especially for CSHCN.

“Previous research has emphasised the importance of care coordination as well as continuity of care through a designated or dedicated personnel especially for CSHCN.34”

• cites [34] World Health Organization (WHO) . Continuity and coordination of care: a practice brief to support implementation of the WHO framework on integrated people-centred health services. 2018.Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

Caution in interpreting the findings is needed given the inconsistencies across these studies.

“However, caution in interpreting the findings is needed given the inconsistencies across these studies.”

Classified as probably not a substantial claim.

The search was limited to English language publications only.

“also, the search was limited to English language publications only”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

The former explanation could lead to inadvertent widening of inequalities, while the latter could be leading to genuine public good, despite increased costs.

“This matters potentially a great deal since the former could lead to inadvertent widening of inequalities (as new interventions may often do), while the latter could be leading to genuine public good, despite increased costs.”