Journal Article•
Efficiency and Cost of a Hospital-Based Medical Home: Children with Special Healthcare Needs
01 Jan 2009-Florida public health review (University of South Florida College of Public Health (USF COPH))-Vol. 6, Iss: 1, pp 85-92
TL;DR: Each of the cost-effectiveness measures were found to be significantly lower post enrollment in the Hospital-Based Medical Home Model.
Abstract: The current study examined two years of pre-post hospital utilization data (the number of emergency room visits, number of unanticipated hospitalizations, and length of stay (LOS)) among forty-nine medically complex children to determine the efficiency and cost effectiveness of a comprehensive Hospital-Based Medical Home Model. Friedman nonparametric analysis was used to examine the pre-post differences for the non-normal distribution. Each of the cost-effectiveness measures (number of emergency room visits, number of unanticipated hospitalizations, and LOS) were found to be significantly lower post enrollment in the Hospital-Based Medical Home Model. Florida Public Health Review, 2009; 6, 85-92. Int tro od
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TL;DR: Although positive, the evidence supporting comprehensive hospital-based programs for children with special health care needs is restricted primarily to nonexperimental studies of children with categorical diseases and is limited by inadequate outcome measures.
Abstract: Objective To examine the effectiveness of hospital-based comprehensive care programs in improving the quality of care for children with special health care needs. Data Sources A systematic review was conducted using Ovid MEDLINE, CINAHL, EMBASE, PsycINFO, Sociological Abstracts SocioFile, and Web of Science. Study Selection Evaluations of comprehensive care programs for categorical (those with single disease) and noncategorical groups of children with special health care needs were included. Selected articles were reviewed independently by 2 raters. Data Extraction Models of care focused on comprehensive care based at least partially in a hospital setting. The main outcome measures were the proportions of studies demonstrating improvement in the Institute of Medicine's quality-of-care domains (effectiveness of care, efficiency of care, patient or family centeredness, patient safety, timeliness of care, and equity of care). Data Synthesis Thirty-three unique programs were included, 13 (39%) of which were randomized controlled trials. Improved outcomes most commonly reported were efficiency of care (64% [49 of 76 outcomes]), effectiveness of care (60% [57 of 95 outcomes]), and patient or family centeredness (53% [10 of 19 outcomes). Outcomes less commonly evaluated were patient safety (9% [3 of 33 programs]), timeliness of care (6% [2 of 33 programs]), and equity of care (0%). Randomized controlled trials occurred more frequently in studies evaluating categorical vs noncategorical disease populations (11 of 17 [65%] vs 2 of 16 [17%], P = .008). Conclusions Although positive, the evidence supporting comprehensive hospital-based programs for children with special health care needs is restricted primarily to nonexperimental studies of children with categorical diseases and is limited by inadequate outcome measures. Additional high-quality evidence with appropriate comparative groups and broad outcomes is necessary to justify continued development and growth of programs for broad groups of children with special health care needs.
76 citations
TL;DR: The findings indicate that hospital-at-home for children is a good solution if the parents are well prepared and feel in control, and Norwegian policymakers should initiate more pilot testing of hospital- at- home for children.
Abstract: In recent decades, there has been a shift from hospitalisation to home care throughout the Western world, even for children. Hospital-at-home for children is in a developmental phase and represents a new service model in Norway. The aim of this pilot study conducted in a Norwegian healthcare setting was to explore how parents with a sick child experienced early hospital discharge and further care at home. The qualitative data are drawn from nine interviews with parents with a child admitted to hospital-at-home. Transcripts of interviews were analysed using a method of qualitative content analysis. In the analysis, Antonovsky's salutogenic perspective on how people cope in demanding life situations was applied. The results show that the parents experienced hospital-at-home as providing a calmer, more predictable family life compared to hospitalisation. They argued that good information and training in medical procedures prior to hospital discharge made hospital-at-home easier to master. The participants pointed out the importance of the professionals' competence and their ability to interact with the child and the parent. The certitude that they could return to the hospital at any time made them feel safe and in control. The parents associated hospital-at-home with a kind of normalisation of their family life. They had a prominent need for normalisation, and this was probably a motivation for agreeing to the hospital-at-home arrangement. The findings indicate that hospital-at-home for children is a good solution if the parents are well prepared and feel in control. In addition, certain structural conditions must be in place before this type of health care is established; there must be a certain volume of patients and the distance to the hospital must be clearly limited. Norwegian policymakers should initiate more pilot testing of hospital-at-home for children. Users and clinicians should be involved in establishing and evaluating these services.
8 citations
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TL;DR: This article views coordination of care through the lens of complexity science in an effort to find new solutions to this healthcare challenge.
Abstract: Clinical and technological advances in medicine have resulted in more patients requiring multidisciplinary care and coordination of services. This is particularly challenging in pediatrics, given the dependency of children. Coordination of care is a key ingredient of quality care; when suboptimal, clinical outcomes and satisfaction can suffer. In this article we view coordination of care through the lens of complexity science in an effort to find new solutions to this healthcare challenge.
61 citations
TL;DR: It is found that for all Medicaid-enrolled children, outpatient costs were significantly higher for female children and children and youth with special health care needs, and medical homeness may affect inpatient costs more than outpatient costs for children and Youth with specialhealth care needs.
Abstract: Objective Our goal was to evaluate the impact of having a medical home on the outpatient medical costs of children and youth with special health care needs. Design Data from 2 sources were matched at the individual level: (1) the 2002 Iowa Consumer Assessment of Health Plans Study survey of Medicaid enrollees and (2) Iowa Medicaid administrative claims, encounter, and enrollment files. Participants The subjects were 1140 children aged 6 months to 12 years for whom both sources of data were available. Main outcome measure(s) Outcomes measures included medical homeness, as developed by a scale of items in the Consumer Assessment of Health Plans Study survey, and outpatient costs, as determined from Medicaid administrative data. Results From the regression models, we found that (1) for all Medicaid-enrolled children, outpatient costs were significantly higher for female children and children and youth with special health care needs, (2) for children and youth without special health care needs, costs were significantly higher for female children, those with a personal doctor or nurse, and those with more of a medical home, and (3) for children and youth with special health care needs, costs were significantly higher for those in a lower health state, for those in health maintenance organization 2, and for older children. Conclusions Although the degree of medical homeness was not related to outpatient costs for children and youth with special health care needs, medical homeness may affect inpatient costs more than outpatient costs for children and youth with special health care needs and should be investigated further.
41 citations
TL;DR: Applying the medical home concept to hospital‐based care coordination may benefit both children with complex conditions and their families, as well as the community‐based providers.
Abstract: The medical home is a conceptual model of continuous and comprehensive care provision that is associated with improved outcomes for children with special healthcare needs. Most applications of the medical home have focused on improving primary care services. Despite concerted efforts to apply the medical home concept to the care of children with special healthcare needs, many barriers to its implementation still exist, in particular, for the subset of children with special healthcare needs who are medically complex. Applying the medical home concept to hospital-based care coordination may benefit both children with complex conditions and their families, as well as the community-based providers.
34 citations
"Efficiency and Cost of a Hospital-B..." refers background in this paper
...They are at an increased risk of hospitalization, length of stay, and intensive care admission (Cooley & McAllister, 2004), frequent medical errors (Sacchetti, Sacchetti, Carraccio, & Gerardi, 2000; Slonim, LaFleur, Ahmed, & Joseph, 2003), poor care coordination (Dosa, Boeing, & Kanter, 2001), and…...
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TL;DR: Targeting children with prior asthma-related ED use and encouraging routine primary care visits as well as the use of an allergist may afford opportunities to reduce ED use among children with asthma currently receiving primary care.
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TL;DR: Care coordination was readily accepted by families and resulted in increased services, but the evaluation proved to be challenging.
Abstract: Families of children with special health care needs face challenges in securing comprehensive health, educational, and social services. As a result, care may be fragmented, duplicative, confusing, and unnecessarily costly. Case management or care coordination is a method of overcoming some of the obstacles experienced by these children and their families. This article describes the Automated Case Management System/Community Based Care Coordination Project for California Children Services Children and Their Families in Los Angeles County (grant number MCJ 065020), a grant project funded by the Maternal Child Health Bureau from October 1987 to December 1990 in which family-centered, community-based care coordination services were provided to a select group of clients and the effectiveness of the interventions was evaluated. Care coordination was readily accepted by families and resulted in increased services, but the evaluation proved to be challenging.
19 citations