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Standardizing Pediatric Somatic Symptom and Related Disorders Care: Clinical Pathway Reduces Health Care Cost and Use
Kristin A Kullgren1, Edwin J Klein2, Julie Sturza3
1Departments of Pediatrics, kullgren@med.umich.edu.
Insights
A new clinical pathway (CP) for pediatric somatic symptom and related disorders (SSRDs) significantly reduced healthcare costs and use in emergency and inpatient settings. This standardized approach offers a more efficient model for managing SSRDs.
Area of Science:
- Pediatrics
- Healthcare Management
- Clinical Pathways
Background:
- Pediatric somatic symptom and related disorders (SSRDs) are prevalent, leading to high healthcare expenditures due to a lack of standardized care.
- This study addresses the need for evidence-based practices in managing pediatric SSRDs.
Purpose of the Study:
- To evaluate the impact of a newly implemented clinical pathway (CP) for SSRD evaluation and management on healthcare costs and utilization.
- To compare the cost and use of care for pediatric patients with SSRDs managed via the CP versus traditional care models in emergency department (ED) and inpatient settings.
Main Methods:
- A retrospective analysis was conducted comparing patients managed with the SSRD CP (P group) against control groups (C and T groups) before and during the CP implementation period.
- Data on costs, length of stay, diagnostic testing, imaging, subspecialty consultations, and readmission rates were collected from electronic health records and a specialized database.
Main Results:
- The inpatient group utilizing the CP demonstrated a significantly shorter length of stay, fewer subspecialty consults, and reduced overall costs compared to control groups.
- The CP led to a median reduction in total costs per patient encounter of $51,433 for the inpatient group and $6,075 for the ED group.
- While imaging costs varied, the CP group generally showed more cost-effective imaging utilization.
Conclusions:
- The implementation of a clinical pathway for pediatric SSRD care resulted in significant reductions in healthcare costs and resource utilization.
- Further research should investigate patient and practitioner experiences with the CP and assess long-term outcomes.
Background:
Pediatric somatic symptom and related disorders (SSRDs) are common with high health care costs and use because of lack of standardized, evidence-based practice. Our hospital implemented a clinical pathway (CP) for SSRD evaluation and management. Our study objective was to evaluate health care cost and use associated with the organization's SSRD CP in the emergency department (ED) and inpatient settings hypothesizing lower cost and use in the CP group relative to controls.
Methods:
We conducted a retrospective analysis of costs and use before and after implementation of the SSRD CP. Data were collected from the hospital's electronic health record and the Pediatric Health Information System database. Participants included pediatric patients on the CP ("P" group) and control groups with an SSRD diagnosis and mental health consultation either the year before the CP ("C" group) or during the CP study period ("T" group). Primary outcomes included costs, length of stay, diagnostic testing, imaging, subspecialty consultation, and readmission rates.
Results:
The ED P group had more lower-cost imaging, whereas the inpatient T group greater higher-cost imaging than other groups. The inpatient P group had significantly shorter length of stay, fewer subspecialty consults, and lower costs. There were no significant group differences in readmission rates. The CP reduced median total costs per patient encounter by $51 433 for the inpatient group and $6075 for the ED group.
Conclusions:
The CP group showed significant reductions in health care cost and use after implementation of a CP for SSRD care. In future work, researchers should explore patient and practitioner experience with the SSRD CP and long-term outcomes.
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