Asylum-Seeking Children with Medical Complexity and Rare Diseases in a Tertiary Hospital in Switzerland
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ORIGINAL PAPER
Asylum‑Seeking Children with Medical Complexity and Rare Diseases in a Tertiary Hospital in Switzerland S. Buser1 · J. Brandenberger1,2 · M. Gmünder1 · C. Pohl3 · N. Ritz1,4,5 Accepted: 1 October 2020 © The Author(s) 2020
Abstract The aim of this study was to assess the characteristics of asylum-seeking children with medical complexity visiting a tertiary care hospital in Switzerland, detailing their underlying medical conditions and management. Asylum-seeking patients with frequent visits between January 2016 and December 2017 were identified using administrative and electronic health records. Of 462 patients, 19 (4%) fulfilled the inclusion criteria with 811 (45%) visits. The age of the 19 patients ranged from 0 to 16.7 years (median of 7 years) with two main age groups identified: 12 years. Nine (47%) patients originated from Syria. A total of 34/811(4%) visits were hospital admissions, 66/811 (8%) emergency department visits and 320/811(39%) outpatient department visits. In children 10 visits in 24 months. Because some children had only recently arrived, the criteria of ≥ 1.5 visits per month with at least 5 visits or 7 cumulative days of hospital admission was also included (Fig. 1).
Data Collection and Analysis Data was extracted from administrative and electronic health records. The following variables were extracted: nationality, age, gender, admission and discharge date, country of birth, escape route, family structure, parental consanguinity, social situation, primary care physician, main diagnoses, vaccination status, and other screenings. Deidentified data was entered in a database (REDCap, Vanderbilt University, 6.9.4). The single data entry was manually reviewed before analysis, REDCap quality control tests were performed, and the records were locked. Matplotlib Python (version 3.0.0, Matplotlib development team) was used for generation of the graphs.
Definitions The visiting period was defined as the number of months from the date of the first visit or January 1, 2016 until December 31, 2017. One visit was defined as one consultation from registration to discharge. Consultations by different departments during one hospital admission were therefore not counted as separate visits since the patient was not discharged in between. If a patient was admitted through the emergency department, this was recorded as an additional emergency department visit but not as an additional total visit to ensure that emergency department visits were not lost. Four types of visits were defined: (i) hospital admission, (ii) emergency department visit, (iii) non-physician visit including exercise therapy, occupational therapy, speech therapy and nutritional counseling, (iv) outpatient visit including 15 different outpatient departments.
Results A total of 462 asylum-seeking patients with 1916 visits were identified in the 2-year time period. Of those, 19 patients were identified as requiring frequent care, resulting in 811 visits included in the final analysis (Fig. 1).
Baseline Characteristics of th
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