Financial and Health Impacts of Multidisciplinary Aerodigestive Care

Skinner, Michael; Lee, Seohee K.; Collaco, Joseph M.; Lefton‐Greif, Maureen A.; Hoch, Jeannine; Yeung, Karla J. Au

doi:10.1177/0194599816637830

Cited by 34 publications

(21 citation statements)

References 12 publications

(26 reference statements)

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“…Aerodigestive programs have been proliferating since their advent in the late 1990s with a goal of improving quality and efficiency of aerodigestive care . The extensive testing proposed by aerodigestive programs is aimed at assessing the possible correlation of esophageal and GI diagnoses on airway symptoms .…”

Section: Discussionmentioning

confidence: 99%

“…Some programs may also include other service lines such as occupational therapy, general pediatrics, genetics, surgery, anesthesiology, and/or radiology . Historically, these specialties have functioned separately “in siloes” versus integrated within a single clinic due to their expense necessitating extensive investment by the hospital …”

Section: Introductionmentioning

confidence: 99%

“…There has been limited research regarding the most effective algorithm of diagnostic testing in the aerodigestive clinic and its subsequent impact on clinical outcomes . The global care models commonly coordinate radiographic studies such as upper gastrointestinal fluoroscopic studies (UGI) and video fluoroscopic swallowing study (VFSS) with consultation from the subspecialists.…”

Section: Introductionmentioning

confidence: 99%

“…1 Historically, these specialties have functioned separately "in siloes" versus integrated within a single clinic due to their expense necessitating extensive investment by the hospital. 2,3 There has been limited research regarding the most effective algorithm of diagnostic testing in the aerodigestive clinic and its subsequent impact on clinical outcomes. [2][3][4][5] The global care models commonly coordinate radiographic studies such as upper gastrointestinal fluoroscopic studies (UGI) and video fluoroscopic swallowing study (VFSS) with consultation from the subspecialists.…”

Section: Introductionmentioning

confidence: 99%

“…2,3 There has been limited research regarding the most effective algorithm of diagnostic testing in the aerodigestive clinic and its subsequent impact on clinical outcomes. [2][3][4][5] The global care models commonly coordinate radiographic studies such as upper gastrointestinal fluoroscopic studies (UGI) and video fluoroscopic swallowing study (VFSS) with consultation from the subspecialists. Most programs have a single procedural day aimed to consolidate diagnostic procedural studies such as flexible bronchoscopy, rigid laryngoscopy/bronchoscopy, esophagogastroduodenoscopy (EGD), and may also include pH multichannel intraluminal impedance probe (pH-MII) under a single anesthesia event.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic

DeBoer

Kinder

Duggar

et al. 2018

Pediatric Pulmonology

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Objective To improve understanding of the interrelatedness of airway and esophageal diagnoses by evaluating the yield of procedural and radiographic testing of the gastrointestinal tract in children with airway conditions by their referring diagnoses in a pediatric aerodigestive clinic. Methods A retrospective chart review of all 325 patients seen in the aerodigestive program from 2010 to 2013 was performed in a single academic medical center. Demographics and results from esophagogastroduodenoscopies with biopsies (EGD), upper gastrointestinal fluoroscopy studies (UGI), and pH multichannel intraluminal impedance probe (pH‐MII) performed within 30 days of the clinic visit were evaluated according to presenting diagnoses. Results Mean patient age was 3.15 years (range 0.15‐24 years) and 41.2% were born premature. 189/325 (58.1%) were on acid suppression. A total of 295 EGD, 193 pH‐MII, and 54 UGI were performed. The most common diagnosis with an abnormal pH‐MII was asthma. The most common diagnoses with an abnormal EGD were feeding difficulty and tracheal esophageal fistula/ esophageal atresia (TEF/EA). EGDs were normal in 188/295 (63.7%), while 39/295 (13.2%) demonstrated esophagitis, and 22/295 (7.5%) had >15 esophageal eosinophils per high power field. The majority of pH‐MII (144/193 [74.6%]) and UGI (47/54 [87%]) were normal. Conclusions Children with feeding difficulty, TEF/EA, and asthma were the mostly likely to have a histologic abnormality on EGD or an abnormal pH‐MII. The majority of children were previously prescribed acid suppression medication and had a referring diagnosis of gastroesophageal reflux disease but were subsequently found to have normal evaluation. Prospective studies are needed to optimize care of this population.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic

DeBoer

Kinder

Duggar

et al. 2018

Pediatric Pulmonology

View full text Add to dashboard Cite

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Assessment of families' experience with care integration within an aerodigestive program

Pottorff,

Liu,

et al. 2023

J. pediatr. gastroenterol. nutr.

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ObjectivesThe objective of this study was to assess if enrollment in a pediatric multidisciplinary aerodigestive program significantly impacted families' experiences with care integration.MethodsA previously validated 48‐question Pediatric Integrated Care Survey (PICS) was administered in a cross‐sectional manner to both new (new‐ADC) and established (est‐ADC) patients presenting for an outpatient Aerodigestive Center visit at Boston Children's Hospital. Survey results were grouped into the following five care coordination domains: (1) access to care, (2) care goal creation/planning, (3) family impact, (4) communication with health care providers, and (5) team functioning. Families were asked to rate their care integration experiences in the prior 12 months using yes/no and Likert‐based questions. Comparisons were analyzed using logistic regression. Factor analysis was also performed.ResultsNinety patient families were surveyed: 54 (60%) est‐ADC patients and 36 (40%) new‐ADC patients. Est‐ADC patients reported higher levels of experience with team functioning, provider awareness of prior testing, provider communication, and access to alternative methods of communication. Self‐identified non‐White patients reported lower satisfaction in team functioning and provider understanding of their child's long‐term care plan. No significant differences in care integration experiences before and after the onset of the coronavirus pandemic were seen.ConclusionsPatients enrolled in aerodigestive centers experienced improved care integration, most significantly in provider communication and team functioning. Despite these improvements, self‐identified non‐White families reported a lower care integration experience.

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Demonstrating the benefits of a multidisciplinary aerodigestive program

et al. 2019

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Objectives/Hypothesis The Aerodigestive Program (the Aero Program) at Children's Hospital Colorado is a multidisciplinary program focused on airway, digestive, and lung disorders in complex children, involving collaboration between gastroenterology, pulmonology, anesthesiology, and otolaryngology in clinic and operating room. These programs have proliferated as institutions focus on providing greater care coordination and family satisfaction. However, few cost, charge, and satisfaction data exist to support these resource‐intensive programs. The goal of this study was to investigate the value of combined triple endoscopy delivered by the Aero Program through analysis of institutional charges, direct costs, operating room efficiency metrics, and parent satisfaction. Study Design Program evaluation. Methods Finance, satisfaction, efficiency, and quality‐of‐care metrics were evaluated within and outside of the Aero Program through retrospective queries of electronic health records, administrative databases, and parent surveys at our institution. Results Mean anesthesia time in the Aero Program was 54 minutes (49–60; 95% confidence interval), which was significantly less (P < .0001) than the estimated 89 minutes of having the three procedures done separately. Average charges and average direct costs for triple endoscopy were 38.8% and 41.9% less than the sum of the averages for separate procedures, respectively. Parent satisfaction was high for the Aero Program care. Conclusions As organizations move toward greater coordination of care for complex patients, multidisciplinary programs must demonstrate their value by delivering cost‐effective care. Aerodigestive programs have the potential to provide satisfying care that is less costly to the organization, insurer, and family. These programs represent a step in the evolution toward higher value care and value‐based payment methodology. Level of Evidence 4 Laryngoscope, 130:521–525, 2020

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Financial and Health Impacts of Multidisciplinary Aerodigestive Care

Abstract: A cohort of children with aerodigestive disease experienced a shift from inpatient to outpatient care with an overall 20% reduction in patient charges when the years before and after MPACT enrollment were compared. Available ICD-9 data suggest potential demand for MPACT services.

Cited by 34 publications

References 12 publications

Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic

Evaluating the yield of gastrointestinal testing in pediatric patients in aerodigestive clinic

Assessment of families' experience with care integration within an aerodigestive program

Demonstrating the benefits of a multidisciplinary aerodigestive program

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