P0578 - Complexity of Documentation Needs for Children with Medical Complexity

Background: Children with medical complexity (CMC) represent a small but fragile subset of children with special healthcare needs. Specialized complex care programs have sprung up with the goal of providing a coordinated and family-centered care for CMC. The creation, utilization, and documentation of clinical care notes constitutes a key part of the work within such programs.

Objective: To describe the purpose and characteristics of clinical care notes utilized within a pediatric complex care program.
Design/

Methods: We employed a qualitative research design to conduct observations of provider-family interactions during complex care clinic visits, and four focus group sessions with members of the complex care team. Focus group sessions were recorded and transcribed. Field observation notes and focus group transcripts were subjected to qualitative content analyses.

Results: Qualitative analyses resulted in four major themes pertaining to functions and characteristics of clinical care notes. (1) Diversity of note types and functions—program staff author and utilize a number of unique note types that in turn are shared across multiple stakeholders including clinicians, families, and payors. (2) Motivations for care note creation are different. (3) Program staff roles, configuration, and relation to care note creation and utilization. (4) Sources of information for creating and updating notes are also diverse. Given the disparate nature of information and sources, integrating and maintaining an up to date information for the child is challenging. To address some of these gaps, program staff even accompany families during specialty clinic visits or visit them in-patient when in hospital to create their own summary information.

Conclusion(s): CMC have complex documentation needs as demonstrated by a variety of professional roles, care settings, and stakeholders involved in the generation, utilization, sharing, and documentation of clinical care notes supporting their care. Multiple opportunities exist to redesign and streamline the existing notes to support the cognitive work of clinicians providing care for CMC.