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A Multidisciplinary Home Visiting Program for Children With Medical Complexity
Elaine Lin1, Kathryn Scharbach2, Bian Liu3,4
1Division of General Pediatrics, Department of Pediatrics and elaine.lin@mountsinai.org.
Insights
A new home-based primary care program for children with medical complexity (CMC) reduced hospital stays and healthcare costs. Increased home visits correlated with fewer emergency department visits and hospitalizations, showing potential for improved outcomes and financial sustainability.
Area of Science:
- Pediatric healthcare innovation
- Complex care management
- Home-based medical services
Background:
- Children with medical complexity (CMC) have high care needs and costs.
- Existing literature lacks home-visiting models for CMC.
- Innovative care delivery is essential for this population.
Purpose of the Study:
- To describe the development of a multidisciplinary, home-based primary care program for CMC.
- To evaluate the outcomes of this novel care model.
Main Methods:
- Retrospective review of medical records for 121 CMC patients (July 2013-March 2019).
- Comparison of pre- and post-program healthcare utilization (length of stay, ED visits, hospitalizations).
- Analysis of cost data and correlation between home visits and healthcare use.
Main Results:
- Program enrollment associated with reduced average length of stay.
- Increased home visits linked to decreased emergency department visits and hospitalizations.
- Total costs of care decreased post-enrollment for patients with available data.
Conclusions:
- The home-based primary care model shows potential for improving health outcomes in CMC.
- This model may offer financial sustainability for managing complex pediatric care.
- Home-visiting programs represent a viable strategy for CMC.
Objectives:
Given the high needs and costs associated with the care of children with medical complexity (CMC), innovative models of care are needed. Home-visiting care models are effective in subpopulations of pediatrics and medically complex adults, but there is no literature on this model for CMC. We describe the development and outcomes of a multidisciplinary program that provides comprehensive home-based primary care for CMC.
Methods:
Medical records from our institution were reviewed for patients enrolled in our program from July 2013 through March 2019. Demographics, clinical characteristics, and health care use were collected. We compared the differences in pre- and postprogram enrollment health care use using Wilcoxon signed rank test. We applied Cox proportional hazard models to examine the association between the time-dependent postenrollment health care use and numbers of home visits. We collected total claims data for a subset of our patients to examine total costs of care.
Results:
We reviewed data collected from 121 patients. With our findings, we demonstrate that enrollment in our program is associated with reductions in average length of stay. More home visits were associated with decreased emergency department visits and hospitalizations. We also observed in patients with available cost data that total costs of care decreased after enrollment into the program.
Conclusions:
Our model has the potential to improve health outcomes and be financially sustainable by providing home-based primary care to CMC.
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