Shared-care planning across primary, secondary and tertiary care

Overview & Definition

Picture a school-age child with epilepsy who sees a tertiary neurologist twice a year, a local paediatrician for intercurrent illness, and a GP for scripts. The neurologist changes the medicine. The letter arrives late. The GP issues the old dose. Mother carries both plans in her handbag. That is multi-level care without shared-care planning. ^{[1] [3]}

Shared care is deliberate co-management of a child’s problems across care levels. Primary care holds whole-child continuity. Secondary care provides local paediatric and ambulatory specialty capacity. Tertiary care concentrates rare expertise, complex procedures and high-intensity programmes. Shared care does not mean every child needs every tier. It means that when more than one team is involved, roles, information and decisions stay coherent. ^{[5] [17] [18]}

Haggerty’s continuity framework still applies. Relational continuity is being known. Informational continuity is usable past information. Management continuity is one coherent plan when several clinicians act. Shared-care planning is how you build management continuity across levels. ^[16]

^{[17] [18] [19]}

References32ShowHide

1. [1]Stille CJ, Primack WA, McLaughlin TJ, et al. Parents as information intermediaries between primary care and specialty physicians Pediatrics, 2007.PMID 18055672
2. [2]Stille CJ, McLaughlin TJ, Primack WA, et al. Determinants and impact of generalist-specialist communication about pediatric outpatient referrals Pediatrics, 2006.PMID 17015522
3. [3]Stille CJ, Korobov N, Primack WA Generalist-subspecialist communication about children with chronic conditions: an analysis of physician focus groups Ambul Pediatr, 2003.PMID 12708892
4. [4]Stille CJ, Antonelli RC Coordination of care for children with special health care needs Curr Opin Pediatr, 2004.PMID 15548935
5. [5]Cooley WC Redefining primary pediatric care for children with special health care needs: the primary care medical home Curr Opin Pediatr, 2004.PMID 15548933
6. [6]Sultan MA, Pastrana CS, Pajer KA Shared Care Models in the Treatment of Pediatric Attention-Deficit/Hyperactivity Disorder (ADHD): Are They Effective? Health Serv Res Manag Epidemiol, 2018.PMID 29623286
7. [7]Seth R Children with Cancer: Shared Care and Transition of Care Indian J Pediatr, 2023.PMID 37368222
8. [8]Slater P, Hastings Y, Nicholson J, et al. Fifteen years of shared care for paediatric oncology, haematology and palliative patients across Queensland: The role of Regional Case Managers Aust J Rural Health, 2023.PMID 36577741
9. [9]Afungchwi GM, Waindim Y, Pondy-Ongotsoyi A, et al. Organization of shared care networks and their role in overcoming challenges and enhancing outcomes for childhood cancer: A systematic review Pediatr Blood Cancer, 2024.PMID 39129132
10. [10]Schraeder K, Allemang B, Felske AN, et al. Community based Primary Care for Adolescents and Young Adults Transitioning From Pediatric Specialty Care: Results from a Scoping Review J Prim Care Community Health, 2022.PMID 35323055
11. [11]Auger KA, Simon TD, Cooperberg D, et al. Summary of STARNet: Seamless Transitions and (Re)admissions Network Pediatrics, 2015.PMID 25489017
12. [12]Feyissa EA, Cornell E, Chandhok L, et al. Impact of Co-management at the Primary-Subspecialty Care Interface on Follow-up and Referral Patterns for Patients With Concussion Clin Pediatr (Phila), 2015.PMID 25573946
13. [13]Altman L, Breen C, Ging J, et al. Dealing with the Hospital has Become too Difficult for Us to Do Alone - Developing an Integrated Care Program for Children with Medical Complexity (CMC) Int J Integr Care, 2018.PMID 30245608
14. [14]Altman L, Zurynski Y, Breen C, et al. A qualitative study of health care providers' perceptions and experiences of working together to care for children with medical complexity (CMC) BMC Health Serv Res, 2018.PMID 29386026
15. [15]Cohen E, Lacombe-Duncan A, Spalding K, et al. Integrated complex care coordination for children with medical complexity: a mixed-methods evaluation of tertiary care-community collaboration BMC Health Serv Res, 2012.PMID 23088792
16. [16]Haggerty JL, Reid RJ, Freeman GK, et al. Continuity of care: a multidisciplinary review BMJ, 2003.PMID 14630762
17. [17]Council on Children with Disabilities Patient- and family-centered care coordination: a framework for integrating care for children and youth across multiple systems Pediatrics, 2014.PMID 24777209
18. [18]McAllister JW, Presler E, Cooley WC Practice-based care coordination: a medical home essential Pediatrics, 2007.PMID 17766512
19. [19]Kuo DZ, McAllister JW, Rossignol L, et al. Care Coordination for Children With Medical Complexity: Whose Care Is It, Anyway? Pediatrics, 2018.PMID 29496973
20. [20]Kuo DZ, Houtrow AJ Recognition and Management of Medical Complexity Pediatrics, 2016.PMID 27940731
21. [21]White PH, Cooley WC Supporting the Health Care Transition From Adolescence to Adulthood in the Medical Home Pediatrics, 2018.PMID 30348754
22. [22]Conners GP, Kressly SJ, Perrin JM, et al. Nonemergency Acute Care: When It's Not the Medical Home Pediatrics, 2017.PMID 28557775
23. [23]Lozano P, Houtrow A Supporting Self-Management in Children and Adolescents With Complex Chronic Conditions Pediatrics, 2018.PMID 29496974
24. [24]Cohen E, Quartarone S, Orkin J, et al. Effectiveness of Structured Care Coordination for Children With Medical Complexity: The Complex Care for Kids Ontario (CCKO) Randomized Clinical Trial JAMA Pediatr, 2023.PMID 36939728
25. [25]Starmer AJ, Spector ND, Srivastava R, et al. Changes in medical errors after implementation of a handoff program N Engl J Med, 2014.PMID 25372088
26. [26]de Banate MA, Maypole J, Sadof M Care coordination for children with medical complexity Curr Opin Pediatr, 2019.PMID 31290774
27. [27]Forrest CB, Chen CP, Perrin EM, et al. Pediatric Medical Subspecialist Use in Outpatient Settings JAMA Netw Open, 2024.PMID 38175643
28. [28]Stille CJ, Frantz J, Vogel LC, et al. Building communication between professionals at children's specialty hospitals and the medical home Clin Pediatr (Phila), 2009.PMID 19286621
29. [29]Christison AL, Vaidya S, Tinajero-Deck L, et al. Application of the Medical Neighborhood to Children with Severe Obesity Child Obes, 2018.PMID 30109953
30. [30]Wisk LE, Finkelstein JA, Sawicki GS, et al. Predictors of timing of transfer from pediatric- to adult-focused primary care JAMA Pediatr, 2015.PMID 26030515
31. [31]Mundy L, Hewson K Thinking outside the system: the integrated care experience in Queensland, Australia Aust J Prim Health, 2019.PMID 31439125
32. [32]Stal J, Piombo SE, Kysh L, et al. The integration of primary care and childhood cancer survivorship care: a scoping review J Cancer Surviv, 2024.PMID 36534343