Interdisciplinary aerodigestive care model improves risk, cost, and efficiency

Boesch, R. Paul; Balakrishnan, Karthik; Grothe, Rayna; Driscoll, Sherilyn W.; Knoebel, Erin E.; Visscher, Sue L.; Cofer, Shelagh A.

doi:10.1016/j.ijporl.2018.07.038

Cited by 27 publications

(17 citation statements)

References 16 publications

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“…These findings suggest several opportunities for improving how lifelong patient‐centered care is delivered. While there is often a focus by providers and healthcare systems in creating multidisciplinary clinics to improve care (Boesch et al, 2018; DeVries et al, 2020; Leong et al, 2020; Shankar & Backeljauw, 2018; Terry et al, 2020), both parents and women reported that flexibility in scheduling, having one provider to oversee their care, and the time commitment for appointments were comparatively more important. Considering these priorities, an innovative approach to delivering care may be increasing the utilization of virtual visits to increase flexibility.…”

Section: Discussionmentioning

confidence: 99%

The transition to independence and adult care for women with Turner syndrome: Current status and priorities of 1338 women and parents

Streur

Floody

Lapham

et al. 2021

American J of Med Genetics Pt A

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Transitioning to adult health care and functioning is crucial for youth and young adults with special health care needs, such as those with Turner syndrome (TS). The International Turner Syndrome Consensus Group developed clinical practice guidelines to improve this transition. This study sought to evaluate how effectively they have been implemented and whether they align with the priorities of women with TS and families of girls and women with TS. A web‐based survey was offered to those affiliated with major TS support organizations, with 1338 successfully responding (n = 543 women [≥18 years]; n = 232 parents of a woman [≥18 years]; and n = 563 parents of a girl with TS [<18 years]). Findings demonstrated that while most women transitioned to adult primary care providers, follow‐up with key specialists was lacking. Women and families prioritized flexibility in appointments and designating one provider to oversee all their TS‐related care. They identified health care coverage as a barrier to receiving care. The transition process to adult care and independence commonly occurred after girls become legal adults. Together, these findings serve to inform strategies to improve the delivery of transitional care for girls and women with TS.

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Section: Discussionmentioning

confidence: 99%

The transition to independence and adult care for women with Turner syndrome: Current status and priorities of 1338 women and parents

Streur

Floody

Lapham

et al. 2021

American J of Med Genetics Pt A

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“…A single-institution retrospective study published in 2019 showed decreased length of time to diagnosis and fewer radiologic and anesthetic exposures in patients who were evaluated in an aerodigestive program when compared to patients with similar conditions evaluated prior to the development of the program [ 15 ]. Another retrospective study showed a decrease in hospital days and lower costs associated with a multidisciplinary aerodigestive evaluation when compared to state averages [ 16 ]. Our retrospective review showed a significant increase in weight z-scores 6-12 months after initial evaluation with a trend towards greater weight gain in those patients who had specific feeding interventions.…”

Section: Discussionmentioning

confidence: 99%

Assessing Pediatric Feeding Disorders by Domain in Complex Aerodigestive Patients

Alexander¹,

Armellino²,

Buchholtz³

et al. 2021

Cureus

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Objective: Pediatric feeding disorder (PFD) is defined as impaired oral intake, associated with dysfunction in at least one of four domains: medical, nutritional, feeding skill, and/or psychosocial. The pediatric aerodigestive patient presents with conditions impacting airway, breathing, feeding, swallowing, or growth. The objective of the study was to determine the prevalence of PFD and dysfunctional domain, in the aerodigestive patient presenting to a tertiary aerodigestive clinic. Methods: Twenty-five charts from patients enrolled in Mayo Clinic Children’s Center Aerodigestive Program were retrospectively reviewed for documentation of dysfunction within the four feeding disorder domains. Results from the aerodigestive triple scope, functional endoscopic evaluation of swallow (FEES), and videofluoroscopic swallow study (VFSS) were recorded. Height and weight z-scores were compared between the initial assessment and 6-12 months later. Results: Median age was 20 months (range 2-81 months). Of the patients, 100% (n = 25) had dysfunction in at least one PFD domain. The domain identified most frequently was medical dysfunction (96%; n = 24). Feeding dysfunction was observed in 76% (n = 19). Psychosocial dysfunction was observed in 76% (n = 19). Nutritional dysfunction was observed in 60% (n = 15). Dysfunction in three or greater domains was seen in 80% (n = 20). Weight z-score increased in 76% (n = 19) of patients 6 to 12 months after the initial aerodigestive evaluation. Conclusion: Aerodigestive patients frequently have PFD and utilizing the consensus definition of PFD at intake may enhance clinical assessment and therapeutic evaluation, and provide a framework to measure outcomes in this heterogeneous patient population.

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“…Recent literature by Galligan et al suggests that aerodigestive clinics often serve as medical homes as many of the patients have breathing, feeding, and gastrointestinal needs, too complex for just the primary care pediatrician communicating independently with individual specialists 2 . In addition to improvements in coordination of care, there may be improvements in overall cost of care for these children 5 . In addition to decreased overall hospital stays, Casey et al described an overall reduction in Medicaid costs when hospital-based multidisciplinary teams were utilized 6 .…”

Section: Discussionmentioning

confidence: 99%

Size and Prevalence of Pediatric Aerodigestive Programs in 2017

Gumer¹,

Rosen²,

Gold³

et al. 2019

J. pediatr. gastroenterol. nutr.

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Objective: Pediatric aerodigestive programs appear to be rapidly proliferating and provide multidisciplinary, coordinated care to complex, medically-fragile children. Pediatric subspecialists are considered essential to these programs. This study evaluated the state of these programs in 2017 by surveying their size, composition, prevalence, and the number of patients that they serve. Methods: The North American Society for Pediatric Gastroenterology Hepatology and Nutrition Aerodigestive Special Interest Group leadership distributed an 11-question survey to the Pediatric Gastroenterology International Listserv. The mean time of the programs' existence, number of half-day clinics, number of procedure days, number of patients evaluated and the lead primary specialty were evaluated. Results: Thirty-four programs responded. Twenty-five were based in academic centers. 31 programs were located across the United States. The average time of program existence was 5.3 years (SD 4.3 range 1-17 years). 64.7% were started in the past five years. Twelve programs were based in the division of gastroenterology. The average number of gastroenterologists serving aerodigestive programs was 2 (SD 1.1). The mean number of half-day clinic sessions and procedure days were 2.8 (SD 2.9) and 2.6 (SD 2) respectively. New and follow-up visits per year in each program averaged 184 (SD 168, range 10-750).

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Interdisciplinary aerodigestive care model improves risk, cost, and efficiency

Cited by 27 publications

References 16 publications

The transition to independence and adult care for women with Turner syndrome: Current status and priorities of 1338 women and parents

The transition to independence and adult care for women with Turner syndrome: Current status and priorities of 1338 women and parents

Assessing Pediatric Feeding Disorders by Domain in Complex Aerodigestive Patients

Size and Prevalence of Pediatric Aerodigestive Programs in 2017

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