Coordinating care for children with complex medical needs can be very difficult. Medically complex patients see their primary care physicians and subspecialists more frequently, visit the emergency department more often, and often require more medications. Many of these patients are also hospitalized at least once each year.
The goal of the Compass Care Program at Children's Hospital of Philadelphia (CHOP) is to improve overall coordination of your child’s care and enhance your experience with your child’s healthcare providers. We focus on the big picture, keeping track of the many different factors impacting your child’s health. This allows all of your child’s providers to have an up-to-date account of her condition and how it’s being managed, and how that may impact her care. We do this on both an inpatient and outpatient basis — during clinic visits, hospital stays, and over the phone between appointments.
Who we treat
Compass Care is for children who are receiving the majority of their specialty care here at CHOP and meet all of the following criteria:
- Are followed by multiple specialists at CHOP
- Have complex, chronic conditions affecting multiple body systems
- Experience several inpatient admissions each year at CHOP
- Often need supporting equipment for functional limitations
- Live within 60 miles of CHOP
Please note that Compass Care is currently a pilot program, and as such is limited to only a small number of patients at this time. Once a child is referred to our program, we will then conduct a thorough evaluation to determine if the program is a good match for your child, or if her care may be effectively managed by a different clinical program that may be a better fit for your child’s needs.
For example, if your child is currently followed by another specialty care clinical program here at CHOP that is already coordinating her specific healthcare needs, she will continue to be seen by that program.
Services we offer
Our team of physicians, nurse practitioners, nurse coordinators and social workers will work with you and your child’s providers to:
- Develop a comprehensive care plan
- Advocate for your child’s healthcare needs
- Coordinate care when your child is admitted to the hospital
- Prepare for the transition from hospital to home
- Coordinate and schedule outpatient visits
- Connect with you when you are at home to assess the needs of your child and family outside the hospital
- Be available between visits to answer questions and address care coordination issues
- Improve communication among your child’s healthcare providers
The Compass Care team partners with your child’s primary care provider and any other specialists your child needs to see. Compass Care does not provide emergency services or primary care.
We work to ensure your child’s providers have access to an up-to-date summary of your child’s care plan so she can receive the best, safest and most effective care.