A hospital-based clinic that coordinated medical, nutritional, and developmental care for medically complex children throughout a single state markedly cut health costs, according to a study published online Feb. 7 in the Archives of Pediatrics and Adolescent Medicine.
This program, which created a hospital-based medical home for the pediatric patients, significantly decreased inpatient visits, lengths of hospital stay, and emergency department visits for children with multiple chronic conditions, resulting in a net reduction of $1,179 per patient per month. Extrapolating from these results, the annual savings in health care costs for a similar statewide population of patients would be $3,183,300, said Dr. Patrick H. Casey and his associates at Arkansas Children’s Hospital, Little Rock.
The investigators evaluated the costs of care before and after the implementation of the Medical Home Clinic at their hospital, which is the only tertiary care center that provides subspecialty and surgical care for children in the state. Outpatient staff includes a neonatologist, developmental pediatricians, hospitalists, general pediatricians, nurses, nutritionists, social workers, speech pathologists, and child psychologists.
In addition to providing health care, the team ensured that community services were provided for patients when necessary. A nurse was available for telephone consultations, coordinating appointments, and assisting with clinical decision-making and acute care issues.
In a retrospective cohort study that they described as "the first examination of the aggregate cost impact of a comprehensive care model for medically complex children," Dr. Casey and his colleagues reviewed the records of 225 children who had at least two serious chronic conditions. The median age of the study subjects was 13 months; 62% were boys and half were white.
Most of the study subjects (67%) had been born preterm. Forty percent had a recognized syndrome or congenital anomaly, 37% had bronchopulmonary dysplasia, 56% required a gastrostomy tube, 7% required a tracheostomy tube, 33% had cerebral palsy, and 72% were developmentally delayed.
The cost of outpatient care increased by $53 per patient per month after the Medical Home Clinic was established, but this rise was more than offset by marked decreases in costs for inpatient care (down by $1,766 per patient per month) and emergency department visits (down by $6 per patient per month).
Both the number of inpatient stays and the length of hospitalizations decreased markedly. The mean length of stay per hospitalization dropped from 14.5 days before the clinic was implemented to 10 days afterward, the investigators said (Arch. Pediatr. Adolesc. Med. 2011 Feb. 7 [doi:10.1001/archpediatrics.2011.5]).
"Future research is needed to determine whether the coordinated and comprehensive care resulted in better patient quality of life and health status, as well as improvement in the quality of life, mental health, satisfactions care, and general well-being of their care providers," Dr. Casey and his associates added.