Impact of a hospital service for adults with chronic childhood-onset disease: A propensity weighted analysis.

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2023-11

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Abstract

Background

Young adults with chronic childhood-onset diseases (CCOD) transitioning care from pediatrics to adult care are at high risk for readmission after hospital discharge. At our institution, we have implemented an inpatient service, the Med-Peds (MP) line, to improve transitions to adult care and reduce hospital utilization by young adults with CCOD.

Objective

This study aimed to assess the effect of the MP line on length of stay (LOS) and 30-day readmission rates compared to other inpatient services.

Methods

This was an observational, retrospective cohort analysis of patients admitted to the MP line compared to other hospital service lines over a 2-year period. To avoid potential confounding by indication for admission to the MP line, propensity score weighting methods were used.

Results

The MP line cared for 302 patients with CCOD from June 2019 to July 2021. Compared to other service lines, there was a 33% reduction in relative risk of 30-day readmission (26.9% compared to 40.3%, risk ratio = 0.67, 95% confidence interval [CI] 0.55-0.81). LOS was 10% longer for the MP line (event time ratio (ETR): 1.10 95% CI 1.0-1.21) with median LOS 4.8 versus 4.5 days. Patients with sickle cell disease had less of a reduction in 30-day readmissions and longer LOS.

Conclusion

Hospitalization for young adults with CCOD on a MP service line was associated with lower 30-day readmission rates and longer LOS than hospitalization on other services. Further research is needed to assess which components of the line most contribute to decreased utilization.

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Published Version (Please cite this version)

10.1002/jhm.13234

Publication Info

Feeney, Colby, Mark Chandler, Alyssa Platt, Shifeng Sun, Noppon Setji and David Y Ming (2023). Impact of a hospital service for adults with chronic childhood-onset disease: A propensity weighted analysis. Journal of hospital medicine. 10.1002/jhm.13234 Retrieved from https://hdl.handle.net/10161/29387.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Feeney

Colby Danielle Feeney

Assistant Professor of Medicine
Platt

Alyssa Platt

Biostatistician III

Education: Masters Degree, Applied Economics.  Duke University. 2007
Bachelors Degree, Economics and Mathematics.  University of North Carolina at Greensboro

Overview: Alyssa has ongoing collaborations with faculty from Duke Global Health Institute, Hospital Medicine, and Center for Aging. She has experience spanning the entire research cycle from grant development and research design, to primary data (or secondary data analysis), and publication of research findings. Alyssa has an MA in applied economics from Duke University and has a range of experience in the fields of health economics, health behaviors and health outcomes, including physician behavior, obesity and physical activity, infectious diseases, and childhood hearing loss. Special areas of expertise are in pilot/feasibility studies, cluster-randomized trials, electronic health records, and health economics.

Setji

Noppon Pooh Setji

Associate Professor of Medicine
Ming

David Yung Ming

Associate Professor of Pediatrics

I am a med-peds hospitalist and researcher with interests in improving systems of care of patients with complex health needs. My research focus areas include implementation science, population health sciences, community-engaged research, and digital health. My vision is to design, implement, evaluate, and scale programs and interventions that will simplify the delivery of complex care. By doing so, we can equitably improve the health outcomes that matter most to children and adults with complex health needs and their families.


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