Integrated Care Facilitation Model Reduces Use of Hospital Resources by Patients with Pediatric Asthma

Abstract

This evaluation assessed a model of care for pediatric asthma patients that aimed to promote health and reduce their preventable and avoidable use of acute hospital services. Pediatric asthma patients (n=223) were allocated care facilitators who provided assistance in the promotion of carer/self-management, education and linkage to an integrated healthcare system, comprising of acute and community-based healthcare providers. Patients' use of acute hospital services (emergency department [ED] presentations, admissions, and bed-days) pre- and postrecruitment were compared using Wilcoxon signed rank tests. The pediatric asthma care givers quality of life questionnaire' was used to assess changes in health and quality of life. The patients displayed a 57% reduction in ED presentations, 74% in admissions, and a 71% reduction in bed-days. Whereas a comparator group displayed 27%, 32%, and 14% increases, respectively. Patients also reported significant improvements in quality of life domains of activity limitation (+5.6, p<.001) and emotional function (+9.1, p<.001). The reduction in the use of hospital services was attributed to the aversion of preventable presentations and admissions, via the enhancement of carer/self-management and access to community health services. These outcomes were supported by indicators of improved patient health and quality of life, and comments by the participant's carers.

Understanding new models of integrated care in developed countries: a systematic review

“…158 In contrast, a greater reduction in use of hospital services was found for COPD rather than heart failure in an international comparator study. 200 Relational co-ordination and integrated care delivery were significantly higher in integrated geriatric units than in other locations (p < 0.001) in another international comparator study. 254 Several studies indicated that targeting interventions to particular populations may lead to positive outcomes.…”

“…Five of the international comparator studies also reported that A&E attendance reduced following interventions by 20.8%, 199 by 57%, 200 by 12.2 per 1000 patients annually, 207 from 705 to 396 attendances (p = 0.03) 210 and from 20.7% to 3% of patients visiting annually (p = 0.02). 237 The interventions included multiple elements of integration, an Accountable Care Organization model and a home-based team (they were delivered to older adult patients in all but two studies 199,200 ). One non-comparator international study 244 supported a reduction in A&E attendance in a general population.…”

“…The evidence from the international literature is mixed, with six comparator studies 201,206,210,211,228,236 evaluating a range of intervention types indicating no significant effect on admissions (all but one 201 of these studies was in older adults). Nine studies 195,199,200,205,207,219,221,222,306 reported a reduction in the number of admissions for patients with a range of conditions; patients included older adults, general groups and those with chronic conditions. One of these studies 195 found that, although admissions rates in one intervention area reduced, in another area they increased.…”

“…There were nine studies evaluating interventions in children and young people. 35,44,66,68,75,200,214,226,238 The interventions were (1) ICPs, (2) MDTs, (3) case co-ordinator and (4) multielement. The studies evaluating pathways 35,44,68 reported (1) positive outcomes of improved communication, (2) staff-perceived improved quality and (3) improved patient satisfaction; however, increased staff contact; no difference in ED attendance or admissions; and variable outcomes regarding length of stay (reduced or no difference).…”

Hospital admissions due to ambulatory care sensitive conditions among children by age group and health region

“…The main cause of ACSCs in children can be found in the environment, the care provided by the child's family, and the vulnerability of the child's immune system (17) ; as opposed to adults were causes are more diversified and vary according to age and lifestyle (18) . The prevalence of admissions due to different ACSCs is therefore different among children when compared to other age groups (1) .…”