Hospital Utilization in Children With Medical Complexity in a Cross-Setting Complex Care Program

Children with medical complexity (CMC) account for disproportionate pediatric hospital utilization. Complex care programs (CCP) may reduce utilization but are often resource intensive. We evaluated whether enrollment in a cross-setting CCP was associated with reduced hospitalizations and inpatient days.

We conducted a retrospective cohort study of CMC enrolled in a children's hospital CCP from 2015 to 2024. The CCP supports cross-setting care through a small team (pediatric hospitalist, nurse practitioner, and community health worker) without dedicated clinic space. Outcomes were annualized hospitalization rates and inpatient days up to 2 years before and after enrollment. We used pre-post comparisons and multivariable negative binomial regression.

Among 71 patients, median hospitalizations decreased from 3.5 to 2.0/year and inpatient days from 41.5 to 11.5/year (both p < .001). Adjusted analyses showed reductions of 32% in hospitalizations and 72% in inpatient days.

CCP enrollment was associated with reduced hospital utilization among CMC.