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Interdisciplinary pediatric aerodigestive care and reduction in health care costs and burden
Joseph M Collaco1, Angela D Aherrera1, Karla J Au Yeung2
1Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland.
Insights
An interdisciplinary pediatric aerodigestive center (PAC) reduced healthcare costs by streamlining care and avoiding anesthesia. This approach offers significant savings and may reduce anesthesia-related risks for children with complex aerodigestive disorders.
Area of Science:
- Pediatric subspecialty care
- Aerodigestive disorders
- Healthcare economics
Background:
- Children with complex respiratory and gastrointestinal issues often need multiple pediatric subspecialists.
- The effectiveness of interdisciplinary pediatric aerodigestive centers is not well-established.
Purpose of the Study:
- To evaluate if an interdisciplinary approach in a pediatric aerodigestive center reduces healthcare costs and patient burden.
- To assess the impact on operative procedures and anesthesia use.
Main Methods:
- Retrospective review of 125 pediatric patients at a tertiary care center's aerodigestive center.
- Interdisciplinary evaluation by gastroenterology, otolaryngology, pulmonology, and speech-language pathology.
- Analysis of operative procedures and estimated hospital charges.
Main Results:
- Average cost savings of $182 per family per visit due to reduced clinic encounters.
- 109 episodes of anesthesia were avoided (41% reduction), saving $1985 per episode.
- Interdisciplinary care reduced hospital charges and potential anesthesia-related risks.
Conclusions:
- Coordinated interdisciplinary care in a pediatric aerodigestive center effectively reduces hospital charges.
- Avoiding multiple anesthesia exposures may mitigate neurocognitive risks.
- Further research should explore caregiver satisfaction and other intangible benefits.
Importance:
Children with complex respiratory and gastrointestinal disorders frequently require care from multiple pediatric subspecialists. Interdisciplinary pediatric aerodigestive clinic centers have been established at several pediatric tertiary care centers in the United States. Their effectiveness is unknown.
Objective:
To determine whether an interdisciplinary approach to pediatric aerodigestive disorders reduces health care costs and burden.
Design, Setting, And Participants:
Retrospective medical record review for the first 125 unique pediatric patients (median age, 1.51 years) seen at the Pediatric Aerodigestive Center (PAC) for aerodigestive disorders between June 2010 and August 2013 for a total of 163 outpatient clinical encounters. The PAC is an academic pediatric tertiary care center where specialists in gastroenterology, otolaryngology, pulmonology, and speech-language pathology provide interdisciplinary evaluation during a single clinic encounter and combined operative management when indicated.
Interventions:
Interdisciplinary evaluation and treatment of pediatric aerodigestive disorders.
Main Outcomes And Measures:
Number of operative procedures and estimated hospital charges related to combining clinic encounters and operative procedures.
Results:
During the initial visit, each of the 125 patients received a mean (SD) of 2.9 (0.8) of a potential 4 services. Estimating per-encounter visit costs for gas, parking, and facility fees, we found that the average cost savings per family per PAC visit was $182. Evaluation under anesthesia was recommended for 85 patients (68%), resulting in 267 operative procedures performed by participating services during 158 encounters with general anesthesia. Thus, 109 episodes of anesthesia were avoided (41% reduction), reducing the risks of anesthesia and related care costs ($1985 per avoided episode).
Conclusions And Relevance:
Coordination of interdisciplinary care in the PAC resulted in a reduction of hospital charges realized through reduction in clinic- and anesthesia-related visits. Reductions in episodes of anesthesia may also reduce neurocognitive risks associated with multiple anesthetic exposures. Other nontangible benefits associated with the coordination of care, such as caregiver satisfaction, warrant further study.
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