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Original Investigation
October 5, 2017

Association of Enrollment in an Aerodigestive Clinic With Reduced Hospital Stay for Children With Special Health Care Needs

Author Affiliations
  • 1Head and Neck Institute, Cleveland Clinic, Cleveland, Ohio
  • 2Pediatric Institute, Cleveland Clinic, Cleveland, Ohio
JAMA Otolaryngol Head Neck Surg. Published online October 5, 2017. doi:10.1001/jamaoto.2017.1743
Key Points

Question  Does enrollment in a multidisciplinary aerodigestive clinic improve outcomes and reduce health care costs by decreasing admissions and inpatient days?

Findings  Our findings demonstrate that enrollment in a multidisciplinary aerodigestive clinic may significantly decrease patient hospital days by an estimated 1 week per year per patient.

Meaning  Coordinated aerodigestive care in a medical home setting improves health care outcomes for children with special health care needs by decreasing length of stay and lowers health care expenditures from a systems-based perspective.

Abstract

Importance  Children with special health care needs (CSHCN) have disproportionate health care utilization. Previous studies have demonstrated that a primary medical home improves health care outcomes for this population.

Objective  To elucidate if enrollment in a multidisciplinary aerodigestive clinic improves outcomes and reduces health care costs by decreasing admissions and inpatient days.

Design, Setting, and Participants  A retrospective medical record review of 113 patients with aerodigestive disorders enrolled in a pediatric multidisciplinary clinic from June 2009 to December 2013 was performed. Of the 113 particpants, 58 (51.3%) were male, 59 (52.2%) had a tracheostomy, and 90 (80.5%) had a gastrostomy tube during their enrollment period. Patient ages at enrollment ranged from 0 to 20 years, with 59 (52.2%) ranging from 0 to 5 years, 23 (20.4%) ranging from 6 to 10 years, 18 (15.9%) ranging from 11 to 15 years, and 13 (11.5%) being 16 years or older.Admissions data before and after enrollment in a pediatric multidisciplinary clinic were examined.

Main Outcomes and Measures  The main outcomes studied were changes in admissions and inpatient days before and after enrollment. Financial data were also examined to determine the reduction in technical direct cost.

Results  The admissions data for 113 children were analyzed. No significant difference in number of admissions per year was seen with enrollment with a median difference of −0.30 admissions per year (range, –10.6 to 6.7 admissions per year; 95% CI, −3.5 to 2.9). However, there was a significant decrease seen in inpatient days per year following enrollment, with a median decrease of 4.1 inpatient days per year (range, –80 to 283.3 inpatient days per year; 95% CI, 0.33 to 91.0). When examining aerodigestive admissions alone, the median number of aerodigestive hospital days avoided per patient was 0.57 days per month, or 6.8 days per year, representing a 70% reduction in technical direct cost.

Conclusions and Relevance  These findings indicate that for children with special health care needs, enrollment in a multidisciplinary aerodigestive clinic may improve health care outcomes by decreasing technical direct cost by 70% and significantly decreasing patient hospital days by an estimated 1 week per year. Furthermore, coordinated aerodigestive care in a medical home setting may lower health care expenditures from a systems-based perspective.

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