Possible Specific Risk Events or Outcomes to Be Targeted by Programs for CMC

DomainsSpecific Risk Events or OutcomesComments and Questions
Health care use• ED visits• These are common targets of CMC programs.
• Readmissions• Are all ED visits or readmissions targeted or just the preventable ones?
• Unnecessary testing• How are preventable or unnecessary defined?
• Costs• Do costs include the potential costs shifted onto families?
Medical outcomes• Patient death• These are all important bad outcomes.
• Specific patient morbidities• However, care must be taken to not create perverse incentives whereby programs are disinclined to enroll patients who are at the highest risk of these outcomes.
• Medication errors
• Hospital-acquired infections
Psychosocial outcomes• Child-patient school absences• A variety of adverse psychosocial outcomes are also important for the child, parents, and family overall.
• Caregiver stress, anxiety, depression• How is the program assessing this domain of outcomes?
• Family financial strain
Parental work of care• Hours spent providing hands-on care• Parents perform most of the tasks required to care for CMC.
• Disruption of nighttime sleep• Is the program monitoring the impact on parents’ work of care and the consequences of changes in parental work of care?
• Absences, leave, or stopping work
Logistical tasks• Approvals for equipment or services• A sizable portion of the CMC work of care involves logistical tasks.
• Scheduling multiple appointments• How is the program measuring and evaluating the intervention’s impact in this domain?
• Transportation difficulties