Strengthening Care for Children: A stepped-wedge translational trial to reduce hospital burden

Australia’s current healthcare for children is neither sustainable nor equitable. Over the past three years there has been a 100% increase to Melbourne's Royal Children's Hospital outpatient clinics and a 26% increase in visits to Sydney Children’s Hospital Network. Similarly, there has been a sustained increase in paediatric Emergency Departments (ED) attendance, with a 5.4% increase in Victoria alone over the same period, at a cost of $26m. Children aged 0-4 years make up 40% of all ED attendees, yet 90% of their lower-urgency triage presentations are for primary care type conditions with 66% of these being referred by GPs. This primary care type use of tertiary paediatric health care settings costs the Australian tax payer an extra $46m per year just for children aged 0-4 years. Further, current care does not offer optimum quality or equity. The recent NHMRC-funded CareTrack Kids study, conducted across three Australian states, found that overall quality of care was adherent for only 60% of indicators across 17 common child health conditions. GP overuse of care was common. We therefore aim to develop and test a novel, integrated model of general practice and paediatrician care that, if effective, will improve access to care, reduce costs to the healthcare system and society, and ensure children receive the right care, at the right time, and in the right place. Results will be of national and international significance.