Reducing Costs, Serious Illnesses for Chronically Ill Children

Comprehensive care compared with usual care for high-risk children with chronic illness reduced total hospital and clinic costs as well as illnesses, according to a new study in JAMA.

Furthermore, clinics that provide both primary and specialty care and offer prompt effective care also increased access to care and parent satisfaction. Emergency department visits, hospitalizations, days in the hospital, intensive care unit (ICU) admissions, and days in the ICU were all reduced.

“With the inadequate current payments for outpatient pediatric care and the necessity to restrain health care spending, the payments required to develop and sustain such medical homes may not be forthcoming unless they are shown to improve outcomes with minimal or no increase in costs,” the authors wrote.

The 201 high-risk patients with chronic illness had 3 or more emergency department visits, 2 or more hospitalizations, or one or more pediatric ICU admissions during the previous year. The children also had a greater than 50% estimated risk for hospitalization.

The researchers found that comprehensive care, or an enhanced medical home, reduced the number of children with a serious illness by 55%. Costs per child receiving comprehensive care was only $16,523 compared with $26,781 for children receiving usual care.

“In this randomized clinical trial, the triple aim of improved care, improved health, and lower costs was achieved in an enhanced medical home providing comprehensive care to high- risk children with chronic illness compared with usual care,” the authors write.

In an editorial in JAMA James M. Perrin, MD, of Harvard Medical School and MassGeneral Hospital for Children in Boston, recommended regular, almost daily, contact with the patient and an intimate knowledge of the patient and their families.

He added that new technologies can also enhance management of complex chronic conditions.

“Equipping families with mobile technologies that would allow them to enter data about their child’s health and wellness status could provide clinic staff real-time information and encourage scheduling of follow-up visits based mainly on the child’s clinical status and less on arbitrary prearranged follow-up times,” Dr Perrin wrote.