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Healthcare Utilization of Complex Chronically Ill Children Managed by a Telehealth-Based Team
Lindsay Braun1,2, Martina Steurer1,2, Duncan Henry1,2
1Department of Pediatrics, University of California, San Francisco, San Francisco, CA, United States.
Insights
A telehealth care team significantly reduced hospital days and admissions for critically ill children with complex conditions. Increased technology use within the team was linked to higher utilization, but not the number of conditions.
Area of Science:
- Pediatric Healthcare
- Telehealth and Digital Health
- Healthcare Management and Policy
Background:
- Medical advances have increased survival rates for critically ill children, leading to a rise in those with complex, ongoing care needs.
- Effective care coordination is crucial for managing children with complex chronic conditions, particularly those requiring extensive geographic support.
- The FamiLy InteGrated Healthcare Transitions (FLIGHT) program utilizes a predominantly telehealth-based team to manage these complex pediatric cases.
Purpose of the Study:
- To compare healthcare utilization (hospital days, admission length) between children managed by the telehealth-based FLIGHT team and matched historical controls.
- To identify risk factors associated with healthcare utilization within the FLIGHT program's telehealth-managed pediatric population.
Main Methods:
- Retrospective cohort study analyzing patients enrolled in the FLIGHT care management team.
- Comparison of healthcare resource utilization between 64 FLIGHT patients and 34 age- and technology-matched historical controls.
- Univariable and multivariable linear regression models were employed to identify risk factors for resource utilization within the FLIGHT cohort.
Main Results:
- FLIGHT patients demonstrated significantly fewer hospital days per year (13.6 vs. 30.3) and shorter admissions (6.0 vs. 17.3 days) compared to controls (p=0.02 for both).
- Within the FLIGHT population, an increased number of medical technologies was associated with more admissions and hospital days per year.
- The number of complex chronic conditions was not found to be a significant risk factor for increased healthcare utilization in the FLIGHT group.
Conclusions:
- A telehealth-based care coordination team effectively reduced key healthcare utilization metrics in a complex pediatric population.
- Telemedicine shows promise for care coordination programs managing children with medical complexity, warranting further investigation.
- Future research should explore the specific impact of technology integration and the optimal use of telemedicine in pediatric complex care.
Abstract:
Objectives: Medical advances have improved survival of critically ill children, increasing the number that have substantial ongoing care needs. The first aim of this study was to compare healthcare utilization of children with complex chronic conditions across an extensive geographic area managed by a predominantly telehealth-based team (FamiLy InteGrated Healthcare Transitions-FLIGHT) compared to matched historical controls. The second aim was to identify risk factors for healthcare utilization within the FLIGHT population. Methods: We performed a retrospective cohort study of all patients enrolled in the care management team. First, we compared them to age- and technology-based matched historic controls across medical resource-utilization outcomes. Second, we used univariable and multivariable linear regression models to identify risk factors for resource utilization within the FLIGHT population. Results: Sixty-four FLIGHT patients were included, with 34 able to be matched with historic controls. FLIGHT patients had significantly fewer hospital days per year (13.6 vs. 30.3 days, p = 0.02) and shorter admissions (6.0 vs. 17.3 days, p = 0.02) compared to controls. Within the telehealth managed population, increased number of technologies was associated with more admissions per year (coefficient 0.90, CI 0.05 - 1.75) and hospital days per year (16.83, CI 1.76 - 31.90), although increased number of complex chronic conditions was not associated with an increase in utilization. Conclusion: A telehealth-based care coordination team was able to significantly decrease some metrics of healthcare utilization in a complex pediatric population. Future study is warranted into utilization of telemedicine for care coordination programs caring for children with medical complexity.
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