Parker Clayten L, Wall Bennett, Tumin Dmitry, Stanley Rhonda, Warren Lana, Deal Kathy, Stroud Tara, Crickmore Kim, Ledoux Matthew
Vidant Medical Center, Greenville, North Carolina; and
Vidant Medical Center, Greenville, North Carolina; and.
Hosp Pediatr. 2020 Aug;10(8):687-693. doi: 10.1542/hpeds.2019-0323. Epub 2020 Jul 8.
Hospital discharge offers an opportunity to initiate coordination of follow-up care, preventing readmissions or emergency department (ED) recidivism. We evaluated how revisits and costs of care varied in a 12-month period between children in a care coordination program at our center (enrolled after hospital discharge with a tracheostomy or on a ventilator) and children with complex chronic condition discharges who were not enrolled.
Children ages 1 to 17 years were retrospectively included if they had a hospital discharge in 2017 with an code meeting complex chronic condition criteria or if they were in active follow-up with the care coordination program. Revisits and total costs of care were compared over 2018 for included patients.
Seventy patients in the program were compared with 56 patients in the control group. On bivariate analysis, the median combined number of hospitalizations and ED visits in 2018 was lower among program participants (0 vs 1; = .033), and program participation was associated with lower median total costs of care in 2018 ($700 vs $3200; = .024). On multivariable analysis, care coordination program participation was associated with 59% fewer hospitalizations in 2018 (incidence rate ratio: 0.41; 95% confidence interval: 0.23 to 0.75; = .004) but was not significantly associated with reduced ED visits or costs.
The care coordination program is a robust service spanning the continuum of patient care. We found program participation to be associated with reduced rehospitalization, which is an important driver of costs for children with medical complexity.
医院出院提供了一个启动后续护理协调的机会，以防止再次入院或急诊科（ED）再就诊。我们评估了在我们中心接受护理协调项目的儿童（出院后登记有气管造口术或使用呼吸机）与未登记的患有复杂慢性病出院儿童在12个月期间的复诊情况和护理费用如何变化。
回顾性纳入2017年出院且诊断代码符合复杂慢性病标准的1至17岁儿童，或正在接受护理协调项目积极随访的儿童。对纳入患者在2018年的复诊情况和护理总费用进行比较。
将项目中的70名患者与对照组的56名患者进行比较。在双变量分析中，2018年项目参与者的住院和急诊就诊合并中位数较低（0对1；P = 0.033），并且参与项目与2018年较低的护理总费用中位数相关（700美元对3200美元；P = 0.024）。在多变量分析中，参与护理协调项目与2018年住院次数减少59%相关（发病率比：0.41；95%置信区间：0.23至0.75；P = 0.004），但与急诊就诊次数或费用减少无显著关联。
护理协调项目是一项涵盖患者护理全过程的强大服务。我们发现参与该项目与再住院率降低相关，而再住院是患有复杂疾病儿童费用的一个重要驱动因素。
