Variation in Hospitalization Rates Following Emergency Department Visits in Children with Medical Complexity

Coller, Ryan J.; Rodean, Jonathan; Linares, Deborah E.; Pulcini, Christian D.; Hall, Matt; Mosquera, Ricardo A.; Casto, Elizabeth; Berry, Jay G.

doi:10.1016/j.jpeds.2019.07.034

Cited by 18 publications

(14 citation statements)

References 36 publications

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“…Moreover, access to specialized care for CMC is reduced when families live far from the hospital and in rural low-serviced communities [ 7 ]. A high proportion of CMC (25.7%) accessing the ED require unplanned hospital admissions, increasing preventable healthcare expenditure [ 7 ]. Conversely, CMC that receive accessible and timely primary care require fewer ED admissions [ 7 , 63 ].…”

Section: Discussionmentioning

confidence: 99%

“…A high proportion of CMC (25.7%) accessing the ED require unplanned hospital admissions, increasing preventable healthcare expenditure [ 7 ]. Conversely, CMC that receive accessible and timely primary care require fewer ED admissions [ 7 , 63 ]. APRN TM care coordination improves team communication, access to healthcare services, and timeliness of planned visits.…”

Section: Discussionmentioning

confidence: 99%

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Impact of telemedicine on health outcomes in children with medical complexity: an integrative review

et al. 2021

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Impact of telemedicine on health outcomes in children with medical complexity: an integrative review

et al. 2021

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“… 1 , 3 , 4 However, some hospitalizations experienced by CMC are avoidable. 5 Substantial variation in hospital utilization for CMC across regions, 6 conditions, 3 and emergency departments 7 suggests opportunities surround us.…”

Section: The Problemmentioning

confidence: 99%

Admitting what is needed: How the health system and society can reduce hospitalizations for children with medical complexity

Chen

Gerber

Coller

2022

Journal of Hospital Medicine

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Hospitalization is a relatively common occurrence for patients with medical complexity. In fact, high health care use is a defining feature of children with medical complexity (CMC). 1 CMC are a heterogeneous and growing population, unified by conceptual similarities: multisystem and frequently progressive chronic conditions leading to substantial functional limitations, familyidentified service needs, and high healthcare use. 1 Annually, approximately 13%-20% of CMC are hospitalized 2,3 and 50%-80% of CMC healthcare spending goes to hospital care. 1,3,4 However, some hospitalizations experienced by CMC are avoidable. 5 Substantial variation in hospital utilization for CMC across

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“… 1 , 2 , 3 These children are defined as having “multiple significant chronic health problems involving multiple organ systems, which result in functional limitations, high health care needs or utilization, and often requires need for, or use of, medical technology.” 4 Children with medical complexity have a high use of the emergency department (ED), and such encounters result in longer lengths of stay, higher resource use, and more frequent hospitalizations compared to children without these conditions. 5 , 6 , 7 , 8 , 9 …”

Section: Introductionmentioning

confidence: 99%

Comparing two definitions of pediatric complexity among children cared for in general and pediatric emergency departments in a statewide sample

Ramgopal

Heneghan

2023

JACEP Open

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Objective The number of children cared for in emergency departments (EDs) with medical complexity continues to rise. We sought to identify the concordance between 2 commonly used criteria of medical complexity among children presenting to a statewide sample of EDs. Methods We conducted a retrospective cross‐sectional study of children presenting to a statewide sample of Illinois EDs between 2016 and 2021. We classified patients as having medical complexity when using 2 definitions (≥1 pediatric Complex Chronic Condition [CCC] or complex chronic disease using the Pediatric Medical Complexity Algorithm [PMCA]) and compared their overlap and clinical outcomes. Results Of 6,550,296 pediatric ED encounters, CCC criteria and PMCA criteria were met in 217,609 (3.3%) and 175,708 (2.7%) encounters, respectively. Among patients with complexity, 100,015 (34.1%) met both criteria, with moderate agreement (κ = 0.49). Children with complexity by CCC had similar rates of presentation to a pediatric hospital (16.3% vs 14.8%), admission (28.5% vs 33.7%), ICU stay (10.0% vs 10.1%), and in‐hospital mortality (0.5% vs 0.5%) compared to children with complexity by PMCA. The most common visit diagnoses for children with CCCs were related to sickle cell disease with crisis (3.9%), abdominal pain (3.6%), and non‐specific chest pain (2.7%). The most common diagnoses by PMCA were related to depressive disorders (4.9%), sickle cell disease with crisis (4.8%), and seizures (3.2%). Conclusions and Relevance The CCC and PMCA criteria of multisystem complexity identified different populations, with moderate agreement. Careful selection of operational definitions is required for proper application and interpretation in clinical and health services research.

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Variation in Hospitalization Rates Following Emergency Department Visits in Children with Medical Complexity

Cited by 18 publications

References 36 publications

Impact of telemedicine on health outcomes in children with medical complexity: an integrative review

Impact of telemedicine on health outcomes in children with medical complexity: an integrative review

Admitting what is needed: How the health system and society can reduce hospitalizations for children with medical complexity

Comparing two definitions of pediatric complexity among children cared for in general and pediatric emergency departments in a statewide sample

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