1038: Post-Icu Healthcare Utilization Among Patients Transitioned to Inpatient Rehabilitation

Introduction: Inpatient rehabilitation may improve outcomes and reduce healthcare use after critical illness, but evidence in pediatrics is limited. We evaluated one-year unexpected healthcare utilization in children discharged to inpatient rehabilitation facilities (IRF) versus home after an intensive care stay. Methods: This retrospective, multicenter cohort study used Pediatric Hospital Information System (PHIS) data. Children 6-months to 18-years, admitted to a pediatric intensive care unit (PICU), with a hospital length of stay (LOS) ≥5 days in 2023 were included. Home (routine) vs IRF discharges were compared. Hospitals reporting < 0.1% discharges to IRF were excluded (assumed to have inaccurate coding), leaving 28 hospitals. The primary outcome was 365-day unexpected healthcare utilization (readmission or ED visit). Key demographic and clinical variables included race, ethnicity, Child Opportunity Index, insurance type, technology dependence, mechanical ventilation, and admission mortality risk. Descriptive, comparative, and regression analyses were performed. Results: IRF discharges comprised 4.8% (840/17,586) of the cohort. Compared to routine discharges, IRF patients were older (median 11 vs 6 years, p< 0.005), non-Hispanic (19.4% vs 24.1%, p< 0.002), technology dependent (50.8% vs 43.0%, p< 0.005), and had longer hospital stays (median 21 vs 9 days, p< 0.005). IRF discharges were more likely to have neurologic (64.4% vs 29.8%) or trauma diagnoses (13.2% vs 2.1%) and higher admission mortality risk (72.3% vs 49.0%, p< 0.005). IRF patients had more readmissions within the first 4 months, but fewer thereafter, and were less likely to have ED visits (9.8% vs 19.4%, p< 0.001) compared to routine discharges. In multivariate analysis, IRF discharge was associated with increased odds of readmission (OR 1.95, 95% CI: 1.66–2.29) but lower odds of ED utilization (OR 0.05, 95% CI: 0.00–0.63). Conclusions: Children discharged to IRFs had higher early healthcare utilization but fewer total readmissions over 365 days. Future research should define which patients benefit most from IRF and clarify its role in reducing unexpected healthcare use after pediatric critical illness.