Indirect Care Utilization Among Children with Medical Complexity

  • Justin C. AlveyEmail author
  • Karen Valentine
  • Jacob Wilkes
  • Tyler Bardsley
  • Colleen Marty
  • Kilby Mann
  • Nancy A. Murphy
Pediatric Rehabilitation Medicine (A Houtrow and M Fuentes, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Pediatric Rehabilitation Medicine


Purpose of Review

Children with medical complexity (CMC) account for 1% of the US pediatric population and 35% of healthcare costs. Comprehensive care for CMC requires high amounts of indirect care time (ICT). We describe the value of ICT for CMC in a mature, consultative, subspecialty complex care program.

Recent Findings

Nine hundred five CMC in our Comprehensive Care Program over a 2-year period received an average of 1283 h of ICT and 640 h of direct visit time per year. Provider costs/year were $93,977 for ICT and $62,848 for direct care provision. The odds of incurring hospital costs increased by 43% among CMC who used ICT.


CMC utilize substantial, costly, and unreimbursed amounts of ICT, yet ICT is associated with increased hospital costs. Perhaps ICT might be a proxy indicator of rising clinical acuity and should prompt escalation of ambulatory care plans; further studies are needed.


Children with medical complexity Complex care Healthcare cost Value 



This study was supported by a grant from the Primary Children’s Hospital Foundation.

Compliance with Ethical Standards

This study was approved by the University of Utah Institutional Review Board.

Conflict of Interest

Justin Alvey, Karen Valentine, Jacob Wilkes, Tyler Bardsley, Colleen Marty, Kilby Mann, and Nancy A. Murphy declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Justin C. Alvey
    • 1
    Email author
  • Karen Valentine
    • 2
  • Jacob Wilkes
    • 2
  • Tyler Bardsley
    • 1
  • Colleen Marty
    • 1
  • Kilby Mann
    • 1
  • Nancy A. Murphy
    • 1
  1. 1.Department of PediatricsUniversity of Utah School of MedicineSalt Lake CityUSA
  2. 2.Intermountain HealthcarePrimary Children’s HospitalSalt Lake CityUSA

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