P2.N274: Establishing a Pediatric Complex Care Program for Western Tennessee: A Quality Improvement Study on Resource Utilization and Staffing Models

Purpose/Objectives: Children are increasingly surviving with recent medical advances, creating a high utilization group whose complex needs often utilize time, resources, and coordination. Almost 86% of children and youth with special health care needs lack services via a well-functioning system. It is difficult to show that programs have significant financial savings, but well defined, coordinated care is needed to address the coexisting medical and social complexity. Inequities experienced by patients and families highlight the need to address social determinants of health and to optimize health care for this population. We developed a complex care program to serve the west Tennessee population. The purpose of this quality improvement project was to quantify the impact and resources for developing a complex care program by analyzing retrospective data. Our goals were to 1) describe the patient population utilizing complex care services, 2) measure resource utilization by patients before and after entry into the program.

Design/Methods: We used quality improvement processes to evaluate the benefits of a complex care program from retrospective data. IRB approval (23-09644-XP) was obtained for this retrospective cohort study. Patients were identified from a master list of complex care patients. Demographic, descriptive, and resource utilization data were obtained through chart review.

Results: For 182 patients in the complex care program, median hospital days 12 months preceding program entry decreased from 2 days (mean: 52 days, SD 6.84) to 0 days in the first 6 months of program entry and at 12 months (mean: 4 days, SD 5.56; 6 days, SD 9.55). Median clinic visits were 5 days (mean: 7 days, SD 6.84) 12 months prior to program entry, which increased to 8.5 days (mean: 9 days, SD 5.56) in the first 6 months and 14 at 12 months (mean: 16 days, SD 9.55) of the program. Median ED visits were 1 day 12 months prior to the program and 1 year after entry into the program (mean: 2 days, SD 2.66 and 3.95), with the first 6 months having a median of 0 ED visits (mean: 1 days, SD 1.95). Average ICU days decreased from 36 days (SD 111.78) 12 months prior to program entry to 1 day (SD 7.74) 6 months into the program and 0 days (1.35) 12 months into the program.

Conclusion/Discussion: Hospital days, ED visits, and ICU days decreased upon entry into a complex care program, but clinic visits increased. This suggests a transition from inpatient care to outpatient care, keeping children at home with their families. This may reflect that children are frequently referred to complex care after prolonged hospitalization, manifesting as a decrease in hospital and ICU days.