Care Coordination Program for Children With Complex Chronic Conditions Discharged From a Rural Tertiary-Care Academic Medical Center.

OBJECTIVES: Hospital discharge offers an opportunity to initiate coordination of follow-up care, preventing readmissions or emergency department (ED) recidivism. We evaluated how revisits and costs of care varied in a 12-month period between children in a care coordination program at our center (enrolled after hospital discharge with a tracheostomy or on a ventilator) and children with complex chronic condition discharges who were not enrolled. METHODS: Children ages 1 to 17 years were retrospectively included if they had a hospital discharge in 2017 with an International Classification of Diseases, 10th Revision code meeting complex chronic condition criteria or if they were in active follow-up with the care coordination program. Revisits and total costs of care were compared over 2018 for included patients. RESULTS: Seventy patients in the program were compared with 56 patients in the control group. On bivariate analysis, the median combined number of hospitalizations and ED visits in 2018 was lower among program participants (0 vs 1; P = .033), and program participation was associated with lower median total costs of care in 2018 ($700 vs $3200; P = .024). On multivariable analysis, care coordination program participation was associated with 59% fewer hospitalizations in 2018 (incidence rate ratio: 0.41; 95% confidence interval: 0.23 to 0.75; P = .004) but was not significantly associated with reduced ED visits or costs. CONCLUSIONS: The care coordination program is a robust service spanning the continuum of patient care. We found program participation to be associated with reduced rehospitalization, which is an important driver of costs for children with medical complexity.

Development of a functional assessment measure for manual wheelchair users.

This investigation developed the Wheelchair Users Functional Assessment (WUFA). Because no functional outcome tools exist that include many of the daily activities that are needed to be independent by individuals using manual wheelchairs, development of an appropriate tool was deemed important. Although the Functional Independence Measure (FIM) can be used to assess disability in those using a wheelchair, it only measures some aspects of basic activities of daily living (ADLs) and does not measure community independence. Therefore, both basic activities and community activities were included in the new tool. A panel of six rehabilitation experts, with input from manual wheelchair users, determined content of the instrument. The resulting WUFA scale includes 13 items. Interrater reliability and stability were established with the calculation of an intraclass correlation coefficient (ICC). ICC for interrater reliability was 0.96 and ICC for stability was 0.78. Further analysis was performed on the internal consistency of the 13-item tool using a sample of 101 tested subjects. This analysis was done using a Cronbach's Alpha. Results indicated excellent internal consistency of the 13 items. The standardized coefficient alpha was 0.96. The WUFA was shown to have content validity, promising interrater reliability and stability, and good internal consistency. Further research is warranted to determine the tool's sensitivity and capability to discriminate between levels of functional independence.