Association of Care Models and Hospital Reutilization for Children With High-Intensity Neurologic Impairment.

Abstract

Background and objectives: Children with medical complexity (CMC), specifically those with high-intensity neurologic impairment (HINI), account for disproportionate amounts of hospital-based health care. Our objective was to explore the association of CMC-dedicated care models, both presence and composition, with hospital reutilization for children with HINI.

Methods: We conducted a retrospective cohort study of hospitals in the Pediatric Health Information System and evaluated hospital survey data and reutilization for children with HINI aged 1 to 18 years. Our exposures were CMC-dedicated care model presence and type (inpatient, outpatient, and combined) as determined via survey data from 31 hospitals. Outcomes were any reutilization, including emergency department returns and rehospitalizations within 14 and 30 days of discharge. Generalized estimating equations were used to generate outcomes based on care model presence, adjusting for clinical and demographic factors.

Results: In total, 66 560 hospitalizations were included; 82.4% occurred at hospitals with at least 1 CMC-dedicated care model. Compared with discharges from hospitals without any CMC care models, discharged children from hospitals with inpatient-only CMC care models experienced lower odds of any reutilization within 14 days (adjusted odds ratio, 0.69; 95% CI, 0.51-0.94), with a similar association observed at 30 days. This association was not observed for other care model types.

Conclusion: Children with HINI are less likely to experience 14- and 30-day health care reutilization when discharged from a hospital that has an inpatient CMC-dedicated care model. Further study is warranted to fully understand the composition of and resources available within CMC-dedicated care models.