Inpatient Consultation for High-Risk Chronically Ill Children Receiving Care in an Enhanced Medical Home: a Pilot Quality Improvement Study

Comprehensive care with Inpatient Consultation: HRCC patients randomized to the comprehensive care with inpatient consultation group that are admitted to CMHH will receive inpatient consultation by HRCC providers during their stay with input and recommendations conveyed to the hospital inpatient team on admission and at discharge at a minimum (in person consultations on weekdays and phone consultations on the weekends). The HRCC providers will review the inpatient care plan and will make treatment and discharge recommendations with a focus on coordination and integration of inpatient and outpatient care. Ideally, the inpatient consultations are face-to-face meetings with the hospital inpatient team but could also be a phone call or a consult note written in the medical record.

High-Risk Children's Clinic (HRCC) patients randomized to the usual inpatient care group who are admitted to Children's Memorial Hermann Hospital (CMHH) will receive usual inpatient care from the primary hospital admitting team (residents and fellows supervised by pediatric faculty physicians) with usual occasional communication with the patient's assigned HRCC provider. HRCC patients admitted to CMHH in this treatment group will receive usual inpatient care that is not modified by the study protocol.