P4A092: Admission to a Dedicated Complex Care Inpatient Hospitalist Team Lowers 7 and 30 Day Readmissions for Children with Medical Complexity

Purpose/Objectives: The objective of this initiative was to reduce the incidence of 7 and 30 day readmissions of children with medical complexity, enrolled in a complex care medical home, when hospitalized at a tertiary medical center.

Design/Methods: In June of 2019, a dedicated inpatient complex care team was established at Dell Children's Medical Center, a freestanding children's hospital. The design of this team included a lower census, more experienced residents later in their training, and a daily coordination of care "huddle" with the primary care team at the complex care medical home. 5 years of hospitalization patterns of children with medical complexity enrolled in the complex care medical home were gathered. Children enrolled in the complex care medical home were admitted to the hospital and assigned to the complex care team or the general hospitalist team on a non randomized basis. Hospitalization patterns and readmission rates were compared between the dedicated complex care team and the cohort hospitalized before the complex care team was established, as well as compared to the cohort nonrandomized to the general hospitalist team. 7 and 30 day readmission rates were the primary outcome. Length of stay was a secondary outcome.

Results: 2158 hospitalizations of children with medical complexity occurred over 5 years. In the 2 years before the complex care team was established, 738 hospitalizations were analyzed. The mean length of stay was 5.44 days (95% CI 4.9-6.1). The 7 day readmission rate was 9.1% and the 30 day readmission rate was 24.9%. In 632 hospitalizations in the cohort non randomized to the complex care team over 3 years, the mean length of stay was 6.53 days (95% CI 5.5-7.3). The 7 day readmission rate was 8.4% and the 30 day readmission rate was 22.6%. There were 788 hospitalizations in the cohort non randomized to the general hospitalist team over 3 years, the mean length of stay was 6.4 days (95% CI 5.5-7.3). The 7 day readmission rate was 10.4% and the 30 day readmission rate was 25%.

Conclusion/Discussion: The dedicated inpatient complex care team represents a package of interventions with lower census and better coordination of care with the primary care medical home. Admitting a child with medical complexity enrolled in a complex medical home to a dedicated inpatient complex care hospitalist team reduced 7 day readmissions by 7.7% and 30 day readmissions by 9.2%. This study provides additional evidence to a growing body of research justifying the inpatient multidisciplinary approach to promote continuity of care for children with frequent and lengthy hospitalizations.