Related Experiment Video
Updated: Oct 21, 2025
A Novel Digital Platform for a Monitored Home-based Cardiac Rehabilitation Program
Published on: April 19, 2019
Complex Care Program Enrollment and Change in ED and Hospital Visits from Medical Device Complications
Christina B Barreda1, Mary L Ehlenbach1, Allison Nackers1
1Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
Insights
Pediatric complex care programs may reduce emergency department visits for medical device complications in children. These programs showed a potential association with more significant reductions, especially for children with enteral tubes.
Area of Science:
- Pediatric Healthcare
- Medical Device Management
- Complex Care Programs
Background:
- Medical device complications frequently lead to emergency department (ED) visits and hospitalizations in children with medical complexity (CMC).
- Pediatric complex care programs are being explored as a strategy to reduce unnecessary healthcare encounters for these children.
Purpose of the Study:
- To evaluate the impact of a pediatric complex care program on ED and inpatient encounters due to medical device complications in CMC.
- To compare the frequency of device complication-related encounters before and after program enrollment.
Main Methods:
- A retrospective cohort study compared 99 CMC enrolled in a complex care program with 244 propensity-matched CMC not enrolled.
- Data on ED and inpatient encounters for device complications were collected from 2014-2016.
- Weighted difference-in-differences (DiDs) analysis estimated the program's effect on encounter frequency.
Main Results:
- Mean annual ED encounters for device complications decreased in both enrolled and comparison groups.
- A difference-in-differences of 0.30 fewer ED encounters per year was observed in the complex care group (95% CI -0.01 to 0.60).
- The most significant reduction in ED visits was seen in CMC with enteral tubes, with 0.36 fewer visits (95% CI 0.04-0.68). Hospitalizations also decreased but without significant group differences.
Conclusions:
- While acute care use for device complications decreased over time for all CMC, complex care program enrollment may be linked to greater reductions in ED visits.
- The benefits of complex care programs appear most pronounced for CMC requiring enteral tubes.
- These findings suggest that complex care programs can play a role in mitigating device-related acute care needs in pediatric populations.
Introduction:
Medical device-related complications often lead to emergency department (ED) visits and hospitalizations for children with medical complexity (CMC), and pediatric complex care programs may be one way to decrease unnecessary encounters.
Methods:
A retrospective cohort study comparing ED and inpatient encounters due to device complications of 2 cohorts of CMC at a single children's hospital during 2014-2016; 99 enrolled in a complex care program and 244 in a propensity-matched comparison group. Structured chart reviews identified ED and inpatient encounters due to device complications. The outcome was a change in the frequency of these encounters from the year before to the year after enrollment in the hospital's complex care program. Program effects were estimated with weighted difference-in-differences (DiDs), comparing the change in mean encounter frequency for CMC enrolled in the program with change for propensity-matched children not enrolled in the program.
Results:
Mean encounters related to device complications decreased for both groups. Complication-related ED encounters per year decreased from a weighted mean (SD) of 0.74 (0.85) to 0.30 (0.44) in enrolled children and 0.26 (0.89) to 0.12 (0.56) in comparison children, a DiD of 0.30 fewer [95% confidence interval (CI) -0.01 to 0.60]. The largest reductions in device complication ED visits were among those with enteral tubes [0.36 fewer (95% CI 0.04-0.68)]. Hospitalizations decreased over time, but DiDs were not significantly different between groups.
Conclusions:
Acute care use from device complications decreased with time. Complex care program enrollment may be associated with more substantial reductions in device complication ED visits, and effects may be most pronounced for CMC with enteral tubes.
Related Concept Videos
01:29Documentation in Long-Term and Home Healthcare Setting
Long-Term Care Facilities
01:30Methods of Documentation VII: EMR
01:15Methods of Documentation VI: Case Management Model
For example, a patient with a chronic...
01:30Pulse rhythm
Conversely, an irregular pulse pattern is termed dysrhythmia, stemming from disruptions in cardiac...
01:25Peritoneal Dialysis II: Peritoneal Dialysis Systems and Complications
01:27Peripheral Artery Disease III: Interprofessional Care