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Background: Children with medical complexity (CMC) are a growing subpopulation of children who require intense engagement with the healthcare system including the involvement of multiple subspecialists and ancillary services. CMC often receive definitive care within children’s hospitals where subspecialty services are concentrated. While studies have reported reductions in emergency department visits and hospitalizations for generally healthy children during the COVID-19 pandemic, the overall impact of the pandemic on CMC has not been well described.

Objective: The objective of this study was to describe the impact of the early COVID-19 pandemic on inpatient utilization for CMC presenting to US children's hospitals.

Design/Methods: We performed a retrospective study of CMC using the Pediatric Health Information System. We examined trends in hospitalizations (total hospitalizations [inpatient or observation], length of stay [LOS], costs, and readmissions) overall and by All Patient Refined Diagnosis Related Groups (APR-DRG) in 2020 compared to 2017-2019. We then compared inpatient utilization and clinical outcomes during the COVID period (March 15 to May 29, 2020) to the same timeframe in the prior 3 years (pre-COVID period). Adjusted generalized linear mixed models were used to examine the association of the COVID period with inpatient utilization. All models included a random hospital effect to account for clustering of discharges at the same hospital.

Results: We observed changes in inpatient hospitalizations overall and by APR-DRG for CMC in 2020 compared to 2017-2019 (Figure 1). We identified 19,868 hospitalizations for CMC within our defined COVID period and another 95,575 hospitalizations for the corresponding pre-COVID period (mean: 31,858 hospitalizations per year). Total hospitalizations in the COVID period declined by a median (IQR) of 39.4% (32.6-44.4%) across hospitals. Of the top 10 most prevalent indications for hospitalization for CMC, 8 conditions experienced declines in hospitalizations during the COVID period (eg, hospitalizations for non-bacterial gastroenteritis declined 30.4%) while 2 conditions experienced increases (eg, hospitalizations for diabetes increased 10.7%) (Table 1). Overall outcomes during the COVID period including length of stay, readmission rates, cost, and mortality remained similar to the pre-COVID period (Table 2).

Conclusion(s): Similar to their non-complex peers, hospitalization volumes for CMC declined during the COVID period though hospital-level outcomes remained largely unchanged.

Presented at the 2021 PAS Virtual Conference

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Presented at the 2021 PAS Virtual Conference

Impact of COVID-19 on Inpatient Utilization and Outcomes for Children with Medical Complexity

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