title: Characteristics of hospitalizations for patients who use a structured clinical care program for children with medical complexity.
abstract: OBJECTIVE
  To describe the characteristics of hospitalizations for patients who use clinical programs that provide care coordination for children with multiple, chronic medical conditions.
  
  
  METHODS
  Retrospective analysis of 1083 patients hospitalized between June 2006 and July 2008 who used a structured, pediatric complex-care clinical program within 4 children's hospitals. Chronic diagnosis prevalence (ie, technology assistance, neurologic impairment, and other complex chronic conditions), inpatient resource utilization (ie, length of stay, 30-day readmission), and reasons for hospitalization were assessed across the programs.
  
  
  RESULTS
  Over the 2-year study period, complex-care program patients experienced a mean of 3.1 ± 2.8 admissions, a mean length of hospital stay per admission of 12.2 ± 25.5 days, and a 30-day hospital readmission rate of 25.4%. Neurologic impairment (57%) and presence of a gastrostomy tube (56%) were the most common clinical characteristics of program patients. Notable reasons for admission included major surgery (47.1%), medical technology malfunction (9.0%), seizure (6.4%), aspiration pneumonia (3.9%), vomiting/feeding difficulties (3.4%), and asthma (1.8%).
  
  
  CONCLUSIONS
  Hospitalized patients who used a structured clinical program for children with medical complexity experienced lengthy hospitalizations with high early readmission rates. Reducing hospital readmission may be one potential strategy for decreasing inpatient expenditures in this group of children with high resource utilization.
authors.affiliation: Division of General Pediatrics, Children's Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Jay G
authors.initials: JG
authors.lastname: Berry
authors.forename: Rishi
authors.initials: R
authors.lastname: Agrawal
authors.forename: Dennis Z
authors.initials: DZ
authors.lastname: Kuo
authors.forename: Eyal
authors.initials: E
authors.lastname: Cohen
authors.forename: Wanessa
authors.initials: W
authors.lastname: Risko
authors.forename: Matt
authors.initials: M
authors.lastname: Hall
authors.forename: Patrick
authors.initials: P
authors.lastname: Casey
authors.forename: John
authors.initials: J
authors.lastname: Gordon
authors.forename: Rajendu
authors.initials: R
authors.lastname: Srivastava
mesh_terms: D000293:Adolescent; D002648:Child; D002662:Child Health Services; D002675:Child, Preschool; D002908:Chronic Disease / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D019538:Health Care Surveys; D006760:Hospitalization / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000639:trends*; D008297:Male; D015995:Prevalence; D012189:Retrospective Studies; D013221:State Health Plans / Q000639:trends*; D014481:United States