Variation in Hospitalization Rates Following Emergency Department Visits in Children with Medical Complexity

Area of Science:

• Pediatric Emergency Medicine
• Health Services Research
• Clinical Pediatrics

Background:

• Children with medical complexity (CMC) represent a vulnerable patient population frequently requiring emergency department (ED) visits.
• Understanding factors influencing hospital admission from the ED for CMC is crucial for optimizing care and resource allocation.
• Existing literature suggests variability in healthcare delivery, but specific patterns for CMC admissions from EDs require further investigation.

Purpose of the Study:

• To identify patient-specific factors associated with hospital admission for children with medical complexity following emergency department encounters.
• To quantify the overall hospital admission rate for CMC visits to emergency departments.
• To assess and quantify the variation in adjusted hospital admission rates across different emergency departments.

Main Methods:

• A retrospective study analyzed 271,806 ED visits across 37 freestanding children's hospitals between January 1, 2014, and June 30, 2017.
• Patients included all ages with a complex chronic condition.
• Generalized linear models were employed to identify associations between patient characteristics and hospital admission likelihood, subsequently calculating adjusted admission rates.

Main Results:

• Hospital admission occurred in 25.7% of all ED visits for CMC.
• Key predictors for hospitalization included multiple prior hospitalizations (≥3 in 365 days), overnight ED arrival, and a higher number of chronic conditions (≥6).
• Significant variation in adjusted hospital admission rates was observed across EDs, ranging from 21.1% to 30.0%, persisting even after excluding certain visit types or restricting the cohort.

Conclusions:

• Children with medical complexity are frequently admitted to the hospital from emergency departments.
• A substantial and significant variation in hospital admission rates for CMC exists across different emergency departments, even after adjusting for case-mix.
• These findings highlight potential areas for quality improvement and standardization of care for CMC in the ED setting.