Hospital Consultation From Outpatient Clinicians for Medically Complex Children: A Randomized Clinical Trial.

摘要: Importance Children with medical complexity (CMC) frequently experience fragmented care. We have demonstrated that outpatient comprehensive care (CC) reduces serious illnesses, hospitalizations, and costs for high-risk CMC. Yet continuity of CMC is often disrupted emergency department (ED) visits hospitalizations. Objective To evaluate a hospital consultation (HC) service from their CC clinicians. Design, Setting, Participants Randomized quality improvement trial at the University Texas Health Science Center Houston an clinic tertiary pediatric (Children’s Memorial Hermann Hospital). included (≥2 hospitalizations or ≥1 intensive unit [PICU] admission in year before enrolling our clinic) receiving CC. Data were analyzed between January 11, 2018, December 20, 2019. Interventions The HC serial discussions clinicians, ED physicians, hospitalists addressing need admission, inpatient treatment, transition back to Usual (UHC) involved routine hospitalist Main Outcomes Measures Total days (primary outcome), PICU days, health system skeptical bayesian analyses (using prior probability assuming no benefit). Results From October 3, 2016, through 2, 2017, 342 randomized either (n = 167) UHC (n = 175) meeting predefined stopping guideline (>80% reduced days). In intention-to-treat analyses, total was 91% (2.72 vs 6.01 per child-year; rate ratio [RR], 0.61; 95% credible interval [CrI], 0.30-1.26). reduction 98% (0.60 0.93 RR, 0.68; CrI, 0.48-0.97), 89% (0.77 1.89 0.59; 0.26-1.38), 94% mean ($24 928 $42 276 cost ratio, 0.67; 0.41-1.10). secondary analysis using centered RR 0.78, reflecting opinion 7 experts knowledgeable about CMC, 96%. Conclusions Relevance Among care, clinicians likely other outcomes, costs. Additional trials are needed centers. Trial Registration ClinicalTrials.gov Identifier:NCT02870387