1199: Regionalization of Pediatric Care and the Role It Has on Recovery: A Single-Center Study

Introduction: Regionalization of pediatric centers offer centralized specialty care for critically ill children, but variation remains in follow-up care for the patients and families at the time of discharge. We hypothesize caregivers who live further from a pediatric healthcare system have increased desire for ICU follow-up care after hospital discharge, regardless of pre-existing conditions. Methods: We conducted a single center survey of children aged 2 weeks-17 years and their caregivers, admitted to a PICU at a quaternary care center hospitalized with acute respiratory distress syndrome (ARDS), acute kidney injury (AKI) and/or sepsis. Caregivers completed surveys on child health and follow-up preferences at the time of enrollment (within 7 days of PICU admission). We compared characteristics among those with versus without preference to see a PICU physician after their child’s critical illness using chi-square and Wilcoxon rank sum. We used multivariable logistic regression to identify association of residential distance from the medical center with request for ICU follow-up after discharge, accounting for age and comorbidity status. Results: Among 101 children, 54.5% were female, with a median age of 68 months (IQR 25-140), and 77.2% had a pre-existing comorbidity. 55.5% had ARDS, 37.6% had AKI, and 54.5% had sepsis. Median distance to the hospital was 37 miles (IQR 22-73). Of 97 who answered the question regarding ICU follow-up; 49% (n=48) stated PICU follow-up would be helpful, while 51% (n=49) did not. Characteristics were similar between those who did vs did not want ICU follow-up: median age 51 (20-157) vs 73 (31-134) months (p=0.72); 75% vs 78% had pre-existing comorbidities (p=0.20), and median residential distance to the hospital was 43 (IQR 22-81) versus 33 (IQR 21-54) miles (p=0.20). On multivariable regression, there was no association between distance to the hospital and request for follow-up (OR 1.01; 95% CI 0.99-1.02). Conclusions: While nearly half of families requested PICU follow-up after discharge, residential distance from the hospital was not associated with desired follow-up. However, as regionalization of care continues, standardizing post PICU follow-up by ICU medical team member may further support patient and family recovery, particularly for those traveling greater distances.