Association of Care Models and Hospital Reutilization for Children With High-Intensity Neurologic Impairment

Area of Science:

• Pediatric Healthcare
• Health Services Research
• Complex Care Management

Background:

• Children with medical complexity (CMC), particularly those with high-intensity neurologic impairment (HINI), utilize a significant portion of hospital resources.
• Understanding factors influencing hospital reutilization for HINI is crucial for optimizing care delivery and resource allocation.

Purpose of the Study:

• To investigate the association between the presence and type of CMC-dedicated care models and hospital reutilization among children with HINI.
• To determine if specific CMC care model compositions impact readmission rates for this population.

Main Methods:

• Retrospective cohort study using the Pediatric Health Information System database.
• Analysis of hospital survey data from 31 hospitals on CMC care model presence and type (inpatient, outpatient, combined).
• Evaluation of reutilization outcomes (ED returns, rehospitalizations within 14 and 30 days) for children with HINI aged 1-18 years, using generalized estimating equations.

Main Results:

• A total of 66,560 hospitalizations were analyzed; 82.4% were at hospitals with CMC care models.
• Discharges from hospitals with inpatient-only CMC care models showed significantly lower odds of 14-day reutilization (aOR, 0.69; 95% CI, 0.51-0.94).
• Similar protective associations were observed for 30-day reutilization, but not for outpatient or combined CMC care models.

Conclusions:

• Hospitals with inpatient-dedicated CMC care models are associated with reduced healthcare reutilization for children with HINI.
• The findings underscore the importance of specialized inpatient care models in managing complex pediatric populations.
• Further research is needed to elucidate the specific components and resources within these effective care models.