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Cost Effectiveness and Impact in Quality of Care of a Pediatric Multidisciplinary Stone Clinic
Jessica M Ming1, Roberto I Lopes1, Elizabeth A Harvey2
1Division of Urology, The Hospital for Sick Children and Department of Surgery, University of Toronto; Toronto, ON, Canada.
Insights
A multidisciplinary clinic for pediatric urinary stones significantly reduced emergency room visits and surgeries. This approach improved care quality and saved costs for children with complex stone disease.
Area of Science:
- Pediatric Urology
- Nephrology
- Health Services Research
Background:
- Pediatric urinary stone disease requires specialized, coordinated care.
- Multidisciplinary clinics aim to streamline treatment and improve patient outcomes.
- Previous management often involved separate urology and nephrology consultations.
Purpose of the Study:
- To evaluate the cost-effectiveness of a multidisciplinary pediatric stone clinic.
- To reduce unnecessary patient visits, diagnostic imaging, and healthcare expenditures.
- To optimize the quality of care for children with urinary stones.
Main Methods:
- A combined pediatric stone clinic was established for complex cases.
- Data on emergency room visits, ultrasounds, and surgeries were collected pre- and post-intervention.
- Patient satisfaction surveys were administered to assess perceived benefits.
Main Results:
- The mean number of emergency room visits per patient decreased significantly (0.29 to 0.10, P=0.002).
- The mean annual cost of emergency room visits and stone-related surgeries also significantly decreased.
- 75% of surveyed families reported the clinic as time-saving.
Conclusions:
- A multidisciplinary clinic intervention led to a significant reduction in emergency room visits and stone-related surgeries for pediatric patients.
- The findings suggest improved efficiency and cost-effectiveness in managing pediatric urinary stones.
- Further long-term data collection is recommended to confirm sustained positive outcomes.
Abstract:
Herein, we assess the cost-effectiveness of a multidisciplinary clinic for children with urinary stones. The clinic's primary goals were to decrease unnecessary visits, imaging, and costs while optimizing the quality of care.
Methods:
Between October 2012 and January 2016, children with complex stone disease, previously treated in urology and/or nephrology clinics, were seen at a triannual pediatric combined stone clinic. We compared the number and cost of ultrasounds, emergency room (ER) visits, and stone surgeries performed before and after each patient's initial evaluation. All patients received satisfaction surveys.
Results:
Among the 79 patients, 27 were seen at least twice in the combined clinic and followed multiple times in either urology or nephrology clinics. The mean number of ER visits per patient per year significantly decreased from 0.29 ± 0.36 to 0.10 ± 0.15 (P = 0.002). The mean cost of ER visits went from CAD$ 23.44 ± 28.80 to CAD$ 4.14 ± 12.18 (P = 0.002). Likewise, the mean annual number and cost of stone-related surgeries significantly decreased [(0.38 ± 0.63 versus 0.20 ± 0.32 after the MSC started (P = 0.026) and mean annual cost of surgeries went from CAD$ 182.97 ± 301.49 to CAD$ 41.59 ± 110.97 (P = 0.022)]. Among the survey responses returned, 75% of families believed the clinic was time-saving.
Conclusions:
Despite a small sample size, the number of ER visits and stone-related operations significantly decreased after the initial combined clinic intervention. Longer-term data will hopefully confirm if the positive findings continue.
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