Objective.-To assess the sustainability of the benefits relative to usual care of a medical home providing comprehensive care for high-risk children with medical complexity (≥2 hospitalizations or ≥1 pediatric intensive care unit [PICU] admission in the year before enrollment) after we made comprehensive care our standard practice and expanded the program. Study design.-We conducted pre-post comparisons of the rate of children with serious illness (death, PICU admission, or >7-day hospitalizations) and health-system costs observed after program expansion (March 2014-June 2015) to those during the clinical trial (March 2011-August 2013) for each of the trial's treatment groups (usual care [n=96]; and comprehensive care [n=105]) (primary analyses), and among all children given comprehensive care (n Post Trial =233 [including trial usual care children who transitioned to comprehensive care post trial and newly enrolled medically complex children]; and n T Trial =105) (secondary analyses). We also analyzed the findings for the trial patients as a 2-phased stepped wedge study. Results.-In intent-to-treat analyses, rates of children with serious illness and costs were reduced or unchanged post trial vs. trial for the trial's usual care group (rate ratio [RR], 0.36 [95% Confidence Interval, 0.20-0.64]; cost ratio [CR], 0.68 [0.28-1.68]), the trial's comprehensive care group (RR, 0.74 [0.39-1.41]); CR, 0.67 [0.51-0.89]), and among all children given comprehensive care (RR, 0.97 [0.61-1.52]; CR, 0.75 [0.61-0.93]). Conservative stepped wedge analyses identified overall benefits with comprehensive care across both study periods (RR, 0.46 [0.30-0.72]; CR, 0.64 [0.43-0.99]).

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Youth involved in the juvenile justice system represent a medically underserved population. Recidivist youth have poorer health outcomes compared to youth detained for the first time. This study determined differences in immunization history, substance use, mental health symptoms, and sexual behavior between recidivist youth and first-time detainees following improvements in intake screenings at a large, urban juvenile detention center in the Southeastern United States. Multivariable logistic regression analysis found that recidivist youth had significantly higher acellular pertussis immunization rates compared with first-time detainees (odds ratio [OR] ¼ 3.3; p ¼ .02), and recidivist males were less likely to test positive for chlamydia (OR ¼ 0.6; p ¼ .03) after controlling for age and Black race. There was no significant difference for most other outcomes between recidivist youth and first-time detainees after controlling for age.