TORONTO – The establishment of an interdisciplinary outpatient clinic for patients with bronchopulmonary dysplasia can significantly improve care and decrease hospital readmissions, reported Dr. Stephen Welty of Columbus Children's Hospital.
Before the establishment of his hospital's outpatient clinic, an analysis of 269 children with bronchopulmonary dysplasia (BPD) discharged to their general follow-up clinic in 2003 revealed that 29% were readmitted within 1 month of discharge, Dr. Welty said at the annual meeting of the Pediatric Academic Societies.
“When we first saw that number we were horrified,” he said. “And for two of those patients their stay [after readmission] was about 6 months, which was quite alarming.”
Staff felt that factors contributing to the high readmission rate included family anxiety and lack of education about caring for their child at home, medical conditions such as reactive airway disease, and resource issues such as living remotely. In addition, BPD patients have complex, multidisciplinary needs that require social, nutritional, and developmental specialists, said Dr. Welty.
“Our hypothesis was that by seeing children at regular scheduled intervals in an interdisciplinary BPD clinic, we would reduce readmission rates,” he said.
The BPD clinic staff saw all patients before discharge to assess the adequacy of oxygenation and whether discharge was realistic, and then saw them again 2 weeks after discharge to reevaluate. A study comparing outcomes within 30 days of discharge found that readmissions went from 29% before the establishment of the BPD clinic, to 3% the first year after its establishment, 6% the second year, and 5% the third year. Dr. Welty suggested this reduction in readmissions was mostly due to the prevention of pulmonary exacerbations.
The study estimated that the BPD clinic resulted in a cost saving of $2.5 million to $3 million per year based on the fact that the average length of stay on readmission was 19 days, with an average cost of $53,600 per patient. The average cost of a BPD clinic visit is $533.
“We believe other potential benefits of the clinic are improved family satisfaction, improved feeding, nutrition and growth, and improved developmental outcomes,” he added.