Care Coordination Program for Children With Complex Chronic Conditions Discharged From a Rural Tertiary-Care Academic...

Area of Science:

• Pediatric Healthcare Management
• Health Services Research
• Chronic Condition Care

Background:

• Hospital discharge is a critical juncture for initiating follow-up care to prevent readmissions and emergency department (ED) visits.
• Children with complex chronic conditions often require extensive care coordination post-discharge.
• Care coordination programs aim to bridge the gap between inpatient and outpatient care for vulnerable pediatric populations.

Purpose of the Study:

• To evaluate the impact of a care coordination program on revisits and healthcare costs in children with complex chronic conditions after hospital discharge.
• To compare outcomes for children enrolled in a care coordination program versus those receiving standard care.

Main Methods:

• Retrospective study including children aged 1-17 discharged in 2017 with complex chronic condition codes or enrolled in a care coordination program.
• Comparison of hospitalizations, ED visits, and total costs of care between program participants and a control group throughout 2018.
• Bivariate and multivariable analyses were used to assess the association between program participation and healthcare utilization and costs.

Main Results:

• The care coordination program group (70 patients) showed a significantly lower median number of combined hospitalizations and ED visits (0 vs 1; P = .033) compared to the control group (56 patients).
• Program participation was associated with significantly lower median total costs of care ($700 vs $3200; P = .024) on bivariate analysis.
• Multivariable analysis revealed that care coordination program participation was linked to a 59% reduction in hospitalizations (IRR: 0.41; P = .004), but not significantly reduced ED visits or costs.

Conclusions:

• Care coordination programs offer a robust approach to managing the continuum of patient care for children with medical complexity.
• Program participation is associated with reduced rehospitalization rates, a key factor contributing to the high costs of care for these children.
• Effective care coordination post-hospital discharge can improve outcomes and potentially mitigate healthcare expenditures for pediatric patients with complex chronic conditions.