Effect of Hospital-Based Comprehensive Care Clinic on Health Costs for Medicaid-Insured Medically Complex Children

Casey, Patrick H.; Lyle, Robert; Bird, T.M.; Robbins, James M.; Kuo, Dennis Z.; Brown, Carrie M.; Lal, Arti; Tanios, Aline; Burns, Katherine

doi:10.1001/archpediatrics.2011.5

Cited by 111 publications

(102 citation statements)

References 35 publications

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“…10,13,14 Reductions in hospital and ED use have been reported with highintensity outpatient care management for subgroups of HRU children. [15][16][17][18] Despite this finding, 40% of children with complex chronic conditions may not have an annual primary care visit. 19 To help inform specific outpatient interventions to achieve quality improvement and cost containment for child HRUs, answers are needed to questions such as, "How does primary care use for child HRUs compare with that of children with lower resource use?"…”

Section: What This Study Addsmentioning

confidence: 99%

Comparison of Health Care Spending and Utilization Among Children With Medicaid Insurance

et al. 2015

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Section: What This Study Addsmentioning

confidence: 99%

Comparison of Health Care Spending and Utilization Among Children With Medicaid Insurance

et al. 2015

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“…8 Some of these programs have reported a major impact on health care utilization and costs, suggesting that they may help interrupt the cycle of persistent health care spending that the children would have experienced otherwise. [9][10][11][12][13] As for their adult counterparts, 14 hospital care is a significant contributor to the overall cost accrued by children with chronic conditions. 2,5,6 Many children who experience high health care costs incur frequent hospital admissions and lengthy hospitalizations.…”

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Hospital Utilization Among Children With the Highest Annual Inpatient Cost

et al. 2016

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BACKGROUND AND OBJECTIVES: Children who experience high health care costs are increasingly enrolled in clinical initiatives to improve their health and contain costs. Hospitalization is a significant cost driver. We describe hospitalization trends for children with highest annual inpatient cost (CHIC) and identify characteristics associated with persistently high inpatient costs in subsequent years.

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“…Several groups have described their experience improving the management of such patients clustered around specialized children's hospitals, each reporting some measure of decreased resource utilization associated with their program. [14][15][16][17][18][19] One group further described their experience of moving the locus of care into community hospitals, achieving further cost savings. 19 As these programs disseminate, the ability to compare their approaches, outcomes, and resource utilization between centers using populationbased data would help every center identify best practices sooner.…”

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confidence: 99%

Hospital Variation in Health Care Utilization by Children With Medical Complexity

et al. 2015

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BACKGROUND: Although children with medical complexity have high health care needs, little is known about the variation in care provided between centers. This information may be particularly useful in identifying opportunities to improve quality and reduce costs. METHODS:We conducted a retrospective population-based observational cohort study using all payer claims databases for children aged 30 days to ,18 years residing in Maine, New Hampshire, and Vermont from 2007 to 2010. We identified hospital-affiliated cohorts (n = 6) of patients (n = 8216) with medical complexity by using diagnostic codes from both inpatient and outpatient claims. Children were assigned to the hospital where they received the most inpatient days, or their outpatient visits if no hospitalization occurred. Outcomes of interest included patient encounters, medical imaging, and diagnostic testing. Adjusted relative rates were calculated with overdispersed Poisson regression models.RESULTS: Adjusting for patient characteristics, the number of inpatient (relative rate 0.84 vs 2.28) and intensive care days (relative rate 0.45 vs 1.28) varied by more than twofold, whereas office (relative rate 0.77 vs 1.12) and emergency department visits (relative rate 0.71 vs 1.37) varied to a lesser extent. There was also marked variation in the use of imaging, and other diagnostic tests, with particularly high variation in electrocardiography (relative rate 0.35 vs 2.81) and head MRI (relative rate 0.72 vs 2.12).CONCLUSIONS: Depending on where they receive care, children with medical complexity experience widely different patterns of utilization. These findings indicate the need for identifying best practices for this growing patient population.WHAT'S KNOWN ON THIS SUBJECT: Children with medical complexity require a disproportionate amount of health services due to a multitude of chronic severe illness, and their impact on the health care system appears to be increasing. WHAT THIS STUDY ADDS:This study provides one of the first comparisons of health care utilization patterns for children with medical complexity between medical centers in a population-based cohort.

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Effect of Hospital-Based Comprehensive Care Clinic on Health Costs for Medicaid-Insured Medically Complex Children

Cited by 111 publications

References 35 publications

Comparison of Health Care Spending and Utilization Among Children With Medicaid Insurance

Comparison of Health Care Spending and Utilization Among Children With Medicaid Insurance

Hospital Utilization Among Children With the Highest Annual Inpatient Cost

Hospital Variation in Health Care Utilization by Children With Medical Complexity

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