Predominant Clinicians and Care Settings for Young Military-Connected Children with Medical Complexity

OBJECTIVE: Military-connected children with medical complexity (CMC) have multifaceted healthcare needs. This study describes the share of ambulatory care delivered to young military-connected CMC within civilian and military health facilities, identifies the predominant clinician providing care, and identifies factors associated with having a predominant clinician at a civilian health facility. METHODS: This retrospective cohort study analyzed United States military Birth and Infant Health Research program data, 2009-2020. The Complex Chronic Condition and Pediatric Medical Complexity algorithms were used to identify CMC <5 years. The clinician and care setting for each ambulatory care visit were determined, and the clinician providing the plurality of care each year from birth through five years was identified. Generalized estimating equations were used to identify factors associated with having a predominant clinician at a civilian health facility. RESULTS: Among 66,920 CMC, 68.7% (n=46,001) received care at both military and civilian health facilities. The proportion with a predominant clinician at a civilian facility ranged from 45.5% (n=17,953) during infancy to 54.5% (n=28,568) by five years. Child-level factors associated with having a civilian predominant clinician included preterm delivery, older age at diagnosis, multisystem disease, and technology dependence. CONCLUSIONS: Two-thirds of military-connected young CMC received ambulatory care across both military and civilian facilities, with increasing reliance on clinicians at civilian facilities beyond infancy and as complexity increased. These findings highlight the importance of coordinated care across healthcare sectors to address the unique needs of military-connected CMC and their families.