Background: Young adults with special health-care needs is a growing population due to medical advances and improved patient outcomes. [1] Unfortunately, the transition into adult medical care for these young adults is often met with declining health and increasing acute care utilization. [2-5] To redesign care for this growing population, we started the Med-Peds service line within the general medicine service in June 2019. The team consists of five hospitalists trained in Internal Medicine and Pediatrics and cares for young adults with chronic childhood-onset disease (CCOD). The most common chronic conditions of patients include type 1 diabetes mellitus, sickle cell disease, inflammatory bowel disease, asthma, and rheumatologic disease. Beyond routine care of the patient, interventions include health care transition assessment and education, social determinants of health screening, and additional care coordination with outpatient providers to facilitate transfer to adult care when appropriate. We aimed to assess care utilization by our patients by comparing discharges by the Med-Peds service to discharges by other hospital services.
Methods: Our patient population included patients admitted at least once to the Med-Peds service line at a single large academic center with 957 inpatient beds. We analyzed inpatient utilization data as a population by evaluating all discharges from the hospital between June 2019 to October 2020 which included discharges from the Med-Peds service line and from other services. These “other services” included other general medicine teams and non-general medicine teams such as Cardiology, Obstetrics, Transplant, etc. All data was extracted from the electronic health record (EHR). Biostatisticians at our institution performed the data analysis. The Institutional Review Board deemed the project exempt.
Results: During the study period, there were 270 individual patients with a total of 783 discharges (~11% of all general medicine discharges). The average age of the patients was 27 years and 57% were female. Patient reported race and ethnicity were as follows: 56% Black or African American, 33% Caucasian/White (97% non-Hispanic), and 11% multiracial/other/refused to answer. Insurance status varied with 37% having Medicaid, 36% private insurance, 19% Medicare, and 8% uninsured. As far as disposition, 84% were discharged home, 12% home with home health services, 3% left against medical advice, and ~1% other. At a population level, med-peds patients had an average length of stay (LOS) of 6.7 days and 30-day readmission rate (RR) of 33.2%. Of the 782 total discharges across the population, 390 (49.9%) were from the Med-Peds service line and 392 (50.1%) were from other services. When patients were discharged by other services, LOS was 6.9 days and RR was 45.5%. When only other general medicine services were evaluated, the patients had RR of 49.1%. However, when patients were discharged by the Med-Peds service line, LOS was 6.5 days and RR was 21.0%.
Conclusions: Young adults with chronic childhood-onset disease are at high risk for readmission. In our analysis, implementation of a Med-Peds service line by Med-Peds physicians was associated with lower 30-day readmission rates compared to care by other hospital services. Further analysis will be done to account for potential confounders. Future investigation is needed to better understand the reasons for this difference and which specific interventions by the Med-Peds service line are most effective at reducing utilization.