Background: The rate of young adults with complex medical needs and chronic illnesses hospitalized at children’s hospitals is increasing faster than any other age group of pediatric patients. There have been multiple studies showing the impact of young adult and adult aged patients as they are admitted to a pediatric hospital, however little has been studied in regards to these complex patients, and their impact on resource utilization in adult hospitals. The purpose of this study is to establish the basis for further research aimed at adults with special health care needs (ASHCN) admitted to adult hospitals. We will be comparing the length of stay of ASHCN with non-ASHCN admitted to adult hospitals with community acquired pneumonia (CAP) and urinary tract infections (UTI).
Methods: We hypothesized that for the principal diagnoses of CAP and UTI, length of stay for ASHCN will be greater than length of stay for non-ASCHN. For the purpose of this study we defined ASHCN as adults under the age of 40 with autism spectrum disorder, cerebral palsy, and developmental delay. Non- ASCHN are defined as all other adults under the age of 40. Data from the national inpatient sample (NIS) database for the year 2016 was utilized for the study. IRB approval was not required. The statistical department of the Medical College of Wisconsin assisted the primary researchers in extracting relevant data, and performing relevant statistical analysis.
Results: This study confirms our hypothesis that length of stay is higher for ASHCN compared with non-ASHCN when admitted to adult hospitals for CAP and UTI. Results summarized in Table 1: Length of Stay and Demographic characteristics among patients with CAP and UTI
Conclusions: Although contributing factors are numerous, establishing the validity of this problem is necessary to find solutions. Of note, national guidelines exist to help foster a smooth transition between pediatric and adult health care settings. Many institutions have focused on creating a multidisciplinary model that assists with this vulnerable time. These teams have sought to break down many of the specific barriers expressed by young adults and families of adults with complex needs, however resources are primarily allocated to transition within the outpatient setting. Little has been studied on best practices of inpatient treatment and guidelines of adults with complex medical needs when they are admitted to adult hospitals and on how to best prepare patients and their families as they transition from the inpatient pediatric setting. By studying healthcare utilization trends of adults with complex medical needs, we will be able to identify opportunities for quality improvement within our health system and identify areas for education in order to better serve this patient population.
