PURPOSE: To describe the change in emergency department and acute hospital care utilization after establishing care in a family-centered medical home for children with medical complexity. METHODS: 358 children with medical complexity, defined as three or more chronic health conditions and technology dependence, were enrolled into a patient- and family- centered medical home situated at a pediatric academic institution starting in July 2017. The medical home offers same day appointments for acute care, twenty-four access to medical home clinicians, and assigns a nurse care coordinator to assist in arranging medical care. Information on emergency department and hospital utilization was obtained from our institution’s data warehouse. We describe emergency department and hospital utilization thirteen months prior to and thirteen months after enrollment using descriptive statistics. RESULTS: From July 2017 to September 2018, 358 families established care in the Complex Care Center. Within this cohort, total emergency department visits decreased from an average of 77.1 visits per month thirteen months prior to enrollment, to 36.5 visits per month thirteen months after enrollment (Figure 1). Similarly, the total number of hospital days decreased from 3195 to 1883 (Figure 2). The total number of hospital admissions in the thirteen months prior to enrollment decreased from 507 to 338 admissions in the thirteen months after (Figure 3). The average length of stay for these hospital admissions decreased from 6.3 to 5.6 days in the thirteen months before and after enrollment in the Complex Care Center, respectively. CONCLUSION: Enrollment in our patient centered medical home decreased emergency department and inpatient hospital utilization for children with medical complexity. Further studies will characterize the differences in child and family characteristics between patients who respond to enhanced care coordination versus those families who do not.
ED Utilization Before & After Enrollment at Complex Care Center
The average number of emergency department visits decreased from 77.1 per month 13 months before enrollment to 36.5 visits per month after enrollment at the Complex Care Center.
ED Utilization Before & After Enrollment at Complex Care Center
The average number of emergency department visits decreased from 77.1 per month 13 months before enrollment to 36.5 visits per month after enrollment at the Complex Care Center.
Hospital Days Before & After Enrollment at Complex Care Center
The total number of hospital days decreased from 3195 days 13 months before enrollment to 1883 days with 13 months after enrollment at the Complex Care Center.
Hospital Days Before & After Enrollment at Complex Care Center
The total number of hospital days decreased from 3195 days 13 months before enrollment to 1883 days with 13 months after enrollment at the Complex Care Center.
Hospital Admissions Before & After Enrollment at Complex Care Center
The total number of hospital admissions decreased from 507 admissions up 13 months before enrollment to 338 admissions 13 months after enrollment at the Complex Care Center.
Hospital Admissions Before & After Enrollment at Complex Care Center
The total number of hospital admissions decreased from 507 admissions up 13 months before enrollment to 338 admissions 13 months after enrollment at the Complex Care Center.
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