Background: Children with medical complexity (CMC) represent less than 1% of all U.S. children but account for over 34% of all pediatric healthcare costs ($110 billion). CMC also account for 34% ($1.6 billion) of all Medicaid pediatric healthcare expenditures and 47% of Medicaid’s total spending on pediatric hospital care. Additionally, this population is expected to double in the next decade as these children are now living longer and surviving with conditions previously believed to be imminently fatal. The purpose of the vKids at Home program is to manage medically complex ambulatory pediatric patients with a virtual physician-led clinical team, utilizing home monitoring technology. Methods: vKids at Home is a virtual service designed to improve quality of life for children with medical complexity. Patients are identified via referrals and by an algorithm that searches the EMR for complex chronically ill children with high utilization of the Emergency Department (ED) and inpatient setting. Patients are provided with an app or iPad and peripheral devices for transmitting vital signs. Patients complete an intake process with a comprehensive assessment of their medical history, psychosocial history, equipment, medications, and providers involved in their care. Clinical action plans are verified with all involved care team members and vKids continually communicates with the patients’ care teams to escalate to in-person visits when necessary. Patients complete a daily, proactive digital touchpoint with the ability to escalate to text message, phone, or video with the virtual care team of nurses, nurse practitioners, social workers, and physicians. Results: There are 137 patients in the program. This population had an average of 4.3 ED visits and 2.5 hospitalizations per patient in the 12 months prior to enrollment. Since enrollment, our patients had a 42% reduction in ED visits per patient per month and a 26% reduction in inpatient admissions. There have been 229 documented instances where the vKids team helped a patient to avoid an unnecessary ED visit in the first 22 months of the program. The team has provided support in a critical situation and provided life-saving care via two-way synchronous audio-video interaction and facilitated safe transition to the hospital. The program has a 95% patient satisfaction rating. Discussion: Children with medical complexity require additional resources to navigate the healthcare system and help facilitate team-based, collaborative care. Our model of a physician-led virtual team can proactively communicate with families via digital surveys, texting, phone, and video visits and has been effective at improving patient and family quality of life as well as reducing unnecessary ED visits and hospitalizations. Next steps include expansion to other regions within our hospital system, expansion to other disease states, and completing an economic evaluation of the program.

Section on Tobacco Control Program