Social Needs of Children With Medical Complexity and Inpatient Care Utilization.

Abstract

Objective: Determine whether children with medical complexity (CMC) with positive social needs screens have more readmissions and longer length of stay (LOS).

Methods: Retrospective cohort study of CMC aged 0 to 21 years admitted to a tertiary care children's hospital from October 1, 2022, to September 30, 2023. Inclusion required at least 3 subspecialists and medical technology use. Caregivers received a link to the questionnaire via text message. Surveys with at least 1 need reported were deemed positive. Thirty-day readmission rates (RRs), total hospital days, and LOS were compared between CMC with and without a positive screen. Analysis included Mann-Whitney test, χ2/Fisher exact test, mixed-effects model for LOS, and multivariable logistic regression for 30-day RR. All P values are 2-sided; P < .05 is considered statistically significant.

Results: Five hundred eighty-three medical records were reviewed; 99 were excluded. Four hundred eighty-four patients remained: 129 positive screens and 355 negative screens. Demographics between groups differed only by race and ethnicity, with more Black/African American and Hispanic/Latinx patients represented in the positive screen group (12.4% vs 7.9%; 45% vs 33.5%; P = .008). CMC with positive screens had a significantly higher 30-day RR (0.36 vs 0.26; odds ratio, 1.56; 95% CI, 1.01-2.40; P = .04) and longer LOS (β = 6; 95% CI, 1-10; P = .01) even after adjusting for potential confounders. They also had more total hospital days (median, 13; IQR, 3-42 vs median, 8; IQR, 3-24), but the difference was not statistically significant (P = .06).

Conclusion: CMC with social needs had significantly higher hospital utilization with more 30-day readmissions and longer hospital stays, trending toward increased hospital days. These findings highlight the impact of social needs on CMC and can inform future interventions to support patients and reduce hospital utilization.