O1131: A Novel, In-home Virtual Care Model for Children with Medical Complexity

Background: Children and adolescents with medical complexity benefit from care coordination and specialized pediatric care, but many barriers exist for access to this type of care. Our hypothesis was that a comprehensive in-home virtual program could be used to provide wraparound care in the home to support patients and families, improve their quality of life, and decrease hospital utilization and cost of care.

Methods: Pediatric patients with complex medical needs were identified and enrolled in a virtual care program with a multidisciplinary team. Over 2.5 years, the team provided wraparound care in the home. A retrospective pre- and post- analysis of data obtained from a state-wide database measured inpatient, outpatient, and emergency department utilization and charges.

Results: Of 127 enrolled children, 75 met the criteria for analysis. Compared to the 12 months prior to enrollment, patients in the program had a 35.3% reduction in hospitalizations (p=0.0268), a 43.9% reduction in emergency visits (p= 0.0005), and a 16.9% reduction in overall charges (p=0.1449). Patient satisfaction was 93%.

Conclusion: A virtual care model providing in-home support and care coordination for medically complex children and adolescents significantly reduced hospitalization and emergency department visits and demonstrated a trend toward reduction in hospital, emergency department, and overall charges for this high-cost vulnerable population. Due to lack of payment mechanism the program was abruptly ended during the pandemic. This new model of technologically enabled care holds immense promise as a means of achieving the quadruple aim in healthcare for children and adolescents with medical complexity but requires proper payment to be sustainable.