Trends in Resource Utilization by Children with Neurological Impairment in the United States Inpatient Health Care System: A Repeat Cross-Sectional Study

Berry, Jay G.; Poduri, Annapurna; Bonkowsky, Joshua L.; Zhou, Jing; Graham, Dionne A.; Welch, Chelsea; Putney, Heather; Srivastava, Rajendu

doi:10.1371/journal.pmed.1001158

Cited by 172 publications

(185 citation statements)

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“…Neurologic impairment is defined as "functional and/or intellectual impairments that result from a variety of neurologic diseases" (eg, anoxic brain injury, lissencephaly). 8 Patients with technology dependence "depend on medical technology to live or remain in their current state of health" (eg, tracheostomy, enteral feeding tube, cerebral spinal fluid shunt). 9,10 The majority of these children (55%) receive outpatient care at CCHMC's Complex Care Center, a medical home that provides primary care to 620 children with severe, chronic disease who receive care from ≥3 subspecialists.…”

Section: Settingmentioning

confidence: 99%

“…However, the discharge process for medically complex patients remained inefficient; only 50% of patients on the HM service with neurologic impairment 8 and/or technology dependence 9,10 were discharged within 2 hours of meeting medical discharge goals. Preliminary work revealed that the medical team often overlooked the particular discharge needs of these medically complex patients and their families until after a child was medically ready for discharge.…”

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confidence: 99%

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Improving Discharge Efficiency in Medically Complex Pediatric Patients

et al. 2016

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BACKGROUND AND OBJECTIVE: Children with medical complexity have unique needs when facilitating transitions from hospital to home. Defining readiness for discharge is challenging, and preparation requires coordination of family, education, equipment, and medications. Our multidisciplinary team aimed to increase the percentage of medically complex hospital medicine patients discharged within 2 hours of meeting medical discharge goals from 50% to 80%. METHODS: We used quality improvement methods to identify key drivers and inform interventions. Medical discharge goals were defined on admission for each patient. Interventions included implementation of a complex care inpatient team with electronic admission order set, weekly care coordination rounds, needs assessment tool, and medication pathway. The primary measure, percentage of patients discharged within 2 hours of meeting medical discharge goals, was followed on a run chart. The secondary measures, pre- and post-intervention length of stay and 30-day readmission rate, were compared by using Wilcoxon rank-sum and χ2 tests, respectively. RESULTS: The percentage of medically complex patients discharged within 2 hours of meeting medical discharge goals improved from 50% to 88% over 17 months and sustained for 6 months. In preintervention–postintervention comparison, median length of stay did not change (3.1 days [interquartile range, 1.8–7.0] vs 2.9 days [interquartile range, 1.7–6.1]; P = .67) and 30-day readmission rate was not impacted (30.7% vs 26.4%; P = .51). CONCLUSIONS: Efficient discharge for medically complex patients requires support of a multidisciplinary team to proactively address discharge needs, ensuring patients are ready for discharge when medical goals are met.

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Section: Settingmentioning

confidence: 99%

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confidence: 99%

Improving Discharge Efficiency in Medically Complex Pediatric Patients

et al. 2016

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“…We used ICD-9-CM diagnostic and procedure codes described in previous studies to identify new medical technology inserted in the terminal admission. [14][15][16]26,27 Medical technology refers to any device that helps maintain health status and physiologic function (eg, gastrostomy or tracheostomy tube). 14 …”

Section: Outcome Measuresmentioning

confidence: 99%

“…Children are increasingly admitted to the hospital for invasive procedures and initiation of medical technologies to maintain health. [14][15][16][17] Consequently, children with LT-CCCs now account for a substantial proportion of pediatric hospital resource use. [17][18][19][20] Although advancements in hospital care have improved life expectancy for some children with LT-CCCs, many ultimately acquire multiple comorbid conditions as they age.…”

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confidence: 99%

Hospital Use in the Last Year of Life for Children With Life-Threatening Complex Chronic Conditions

et al. 2015

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BACKGROUND AND OBJECTIVES: Although many adults experience resource-intensive and costly health care in the last year of life, less is known about these health care experiences in children with life-threatening complex chronic conditions (LT-CCCs). We assessed hospital resource use in children by type and number of LT-CCCs. WHAT THIS STUDY ADDS:Hospital use in the last year of life for these children varies by type and number of LT-CCCs. Most children with $3 LT-CCCs are admitted to the hospital for more than 2 months in the last year of life.

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“…Factors to consider when evaluating the economic impact of these disorders include the costs of diagnostic tests, medical services, referrals to specialists, medications, social services for children, and missed work or underemployment for caregivers. 9 Analyses based on the Kids' Inpatient Databases found that seizures accounted for 16.9% of hospital admissions in 2006, 10 with an estimated annual cost per patient of $4,553.…”

Section: Model Structure and Inputsmentioning

confidence: 99%

Budget Impact Analysis of Antiepileptic Drugs for Lennox-Gastaut Syndrome

Skornicki¹,

Clements²,

O’Sullivan³

2014

JMCP

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BACKGROUND: In October 2011, clobazam was FDA-approved for adjunctive treatment of seizures associated with Lennox-Gastaut syndrome (LGS), a debilitating childhood epilepsy characterized by drop attacks, for patients 2 years and older.OBJECTIVE: To assess the budget impact of adding clobazam to an antiepileptic drug (AED) portfolio containing topiramate, lamotrigine, and rufinamide in a hypothetical, 100,000-member commercially insured health plan.METHODS: Patient characteristics and AED efficacy (decrease in dropseizure frequency) were modeled with clinical data. Medical costs were derived from administrative claims data from a large U.S. managed health plan, with the assumption that 2.3% of drop seizures required medical care. Two-year budget impact was measured. Results were expressed as the overall difference in costs (medical and pharmacy) to a health plan and cost per member per month (PMPM) after addition of clobazam. Analyses of alternative scenarios were performed.RESULTS: With the assumption that 0.04% of the plan population had LGS, adding clobazam to the formulary resulted in cost savings of $98,059 in year 1 and $131,690 in year 2 (savings of $0.08 and $0.11 PMPM, respectively). Analyses of alternative scenarios with lower seizure rates upon discontinuation or greater long-term efficacy for lamotrigine and topiramate did not substantially alter conclusions. The assumption that fewer drop seizures required medical care resulted in a savings of approximately $5,000 per year with clobazam, which suggested that medically attended drop seizures drive costs.CONCLUSIONS: Medically attended drop seizures are a major cost driver for LGS patients. Adding clobazam to a health plan formulary can have a positive overall budget impact through decreased medical costs associated with drop seizures.

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Trends in Resource Utilization by Children with Neurological Impairment in the United States Inpatient Health Care System: A Repeat Cross-Sectional Study

Abstract: Jay Berry and colleagues report findings from an analysis of hospitalization data in the US, examining the proportion of inpatient resources attributable to care for children with neurological impairment.

Cited by 172 publications

References 36 publications

Improving Discharge Efficiency in Medically Complex Pediatric Patients

Improving Discharge Efficiency in Medically Complex Pediatric Patients

Hospital Use in the Last Year of Life for Children With Life-Threatening Complex Chronic Conditions

Budget Impact Analysis of Antiepileptic Drugs for Lennox-Gastaut Syndrome

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