Comprehensive Follow-up Care and Life-Threatening Illnesses Among High-Risk Infants

Abstract

Comprehensive follow-up care by experienced caregivers can be highly effective in reducing life-threatening illness without increasing costs among high-risk inner-city infants. JAMA. 2000;284:2070-2076.

Effect of an Enhanced Medical Home on Serious Illness and Cost of Care Among High-Risk Children With Chronic Illness

“…36 Nevertheless, the findings are similar to those in a prior trial of comprehensive care at a different center in which 887 high-risk infants were randomized to comprehensive or usual care from the same clinicians after discharge from a neonatal ICU. 16 The RR for the outcome of lifethreatening illness (death or pediatric ICU admission) was virtually identical in both trials (0.52-0.53). The higher absolute cost savings in our trial reflects both a higher-risk population and inflation.…”

Post-Trial Sustainability and Scalability of the Benefits of a Medical Home for High-Risk Children with Medical Complexity

“…We believe the continued success of our medical home model of primary care likely results from the sustained effort to promote prompt and effective care at all hours and to identify and reduce unnecessary ED visits and hospitalizations through a combination of features such as: 1) a low patient-to-provider ratio to allow for frequent, proactive communication with the parents by phone and e-mail; 2) cell phone access to primary care providers 24/7; 3) acute same day care, chronic care, and specialty care all provided in the same clinic; 4) extensive provider-to-provider consultation; 5) weekly scrutiny of the care provided in the clinic before any ED visit or hospitalization; and 6) prompt clinic visits after ED visits or hospitalization. As indicated in prior systematic reviews (6)(7)(8)11), similar features were used in the only other randomized trial of a medical home that identified major clinical benefits or cost reductions (12). Given the complexity and amount of resources needed to replicate our medical home model of complex care, the benefits we identified both during and after the trial seem only likely to be achievable in academic centers with the adequate staffing, infrastructure, and commitment to provide such care.…”

Research Review: Integrated healthcare for children and young people in secondary/tertiary care – a systematic review

“…Ten out of 17 studies reported at least one significant outcome favouring integrated care (Figure 2). Programs with care coordination components led to a significantly higher rate of medical outpatient appointments in both pre–post and cohort studies (Broyles et al., 2000; Cohen et al., 2010; Gordon et al., 2007; Svoren, Butler, Levine, Anderson, & Laffel, 2003). Interventions providing an integrated system of care of mental health services (from community to hospital) reported significantly higher receipt of non‐acute mental health services than comparison populations in all three studies (Bickman, 1996; Bickman, Noser, & Summerfelt, 1999; Bickman, Summerfelt, & Noser, 1997; Grimes, Kapunan, & Mullin, 2006; Hamner, Lamberg, & Bickman, 1997).…”

“…Two out of five RCTs that described case management interventions showed significant differences in medical outcomes favouring the intervention group (Broyles et al., 2000; Gillette et al., 1991; Howe et al., 2005; O'Shea et al., 2007; Svoren et al., 2003).…”

“…Interventions providing increased support and follow‐up at home after early discharge, as an alternative to prolonged inpatient stay for populations of very low birthweight infants, showed no difference compared to controls in rehospitalisation rates, acute care visits or length of stay (Brooten et al., 1986; Casiro et al., 1993). In contrast, home visiting to provide additional support as part of a comprehensive programme for infants discharged from neonatal intensive care or with failure to thrive showed significantly lower rehospitalisation rates in the intervention compared to control group (Broyles et al., 2000; Finello, Litton, deLemos, & Chan, 1998; Raynor et al., 1999).…”