A Population Intervention to Improve Outcomes in Children With Medical Complexity

Area of Science:

• Pediatric Health Services Research
• Quality Improvement in Healthcare
• Value-Based Care Models

Background:

• Children with medical complexity often face fragmented, costly, and inefficient healthcare.
• Value-based contracting incentivizes healthcare systems to enhance care delivery and outcomes.
• Neurologically impaired children requiring feeding tubes represent a high-need, high-cost population.

Purpose of the Study:

• To improve health outcomes, healthcare value, and utilization for children with neurologic impairment and feeding tubes.
• To implement a quality improvement initiative within a population-based cohort.
• To reduce healthcare costs and improve patient well-being for a vulnerable pediatric population.

Main Methods:

• A freestanding children's hospital and accountable care organization collaborated on a quality improvement initiative.
• Interventions targeted children with percutaneous feeding tubes, neurologic diagnoses, and Medicaid insurance.
• Key initiatives included standardized feeding tube management, enhanced family education, and a care coordination program.

Main Results:

• An 18.0% decrease in admissions and a 31.9% decrease in average length of stay were observed.
• Total inpatient charges decreased by over $11.7 million.
• An 8.2% increase in children achieving healthy weight percentiles and enrollment of 58.3% of the cohort in care coordination were noted.

Conclusions:

• Population-based initiatives can significantly improve care for children with medical complexity.
• The study demonstrated reduced healthcare charges and improved weight status in the target population.
• Collaborative, institutional efforts within accountable care organizations can enhance outcomes and value for complex pediatric patients.