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Development and Evaluation of an Integrated Outpatient Infusion Care Model for the Treatment of Pediatric Headache
Hannah F J Shapiro1, Jenifer Sant1, Anna Minster1
1Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
Insights
Developing an outpatient infusion center for pediatric headache care significantly reduces treatment costs compared to emergency departments and inpatient settings. This model also decreased emergency visits and hospital admissions for pediatric headache patients.
Area of Science:
- Pediatric Neurology
- Health Services Research
- Quality Improvement
Background:
- Pediatric headache management often occurs in high-cost emergency departments (EDs) and inpatient settings.
- Outpatient infusion centers offer a potential solution to reduce care costs for pediatric headache treatment.
Purpose of the Study:
- To describe the development of an integrated outpatient pediatric headache infusion care model.
- To compare the costs of this model against emergency and inpatient settings.
- To assess the impact on ED visits, inpatient admissions, and treatment efficacy.
Main Methods:
- Quality improvement study detailing the creation of an outpatient infusion center for pediatric headache.
- Cost comparison between the infusion center, ED, and inpatient settings, with separate analysis for dihydroergotamine (DHE) infusions.
- Run charts used to track ED visits and inpatient admissions; efficacy compared between infusion care and inpatient settings.
Main Results:
- Inpatient treatment costs increased by 61% (with DHE) and 582% (without DHE) compared to the infusion center.
- ED treatment costs increased by 30% compared to the infusion center.
- Post-intervention, ED visits and inpatient admissions for headache decreased, with similar pain reduction across settings.
Conclusions:
- Developing an integrated ambulatory care model with infusion capacity for refractory pediatric headache is feasible.
- Early outcomes suggest this model favorably impacts the overall value of care for pediatric headache patients.
- Outpatient infusion centers can provide cost-effective and efficient care for pediatric headache.
Background:
Care for pediatric patients with headache often occurs in high-cost settings such as emergency departments (EDs) and inpatient settings. Outpatient infusion centers have the potential to reduce care costs for pediatric headache management.
Methods:
In this quality improvement study, we describe our experience in creating the capacity to support an integrated outpatient pediatric headache infusion care model through an infusion center. We compare costs of receiving headache treatment in this model with those in the emergency and inpatient settings. Because dihydroergotamine (DHE) is a costly infusion, encounters at which DHE was administered were analyzed separately. We track the number of ED visits and inpatient admissions for headache using run charts. As a balancing measure, we compare treatment efficacy between the infusion care model and the inpatient setting.
Results:
The mean percentage increase in cost of receiving headache treatment in the inpatient setting with DHE was 61% (confidence interval [CI]: 30-99%), and that without DHE was 582% (CI: 299-1068%) compared with receiving equivalent treatments in the infusion center. The mean percentage increase in cost of receiving headache treatment in the ED was 30% (CI: -15 to 100%) compared with equivalent treatment in the infusion center. After the intervention, ED visits and inpatient admissions for headache decreased. The mean change in head pain was similar across care settings.
Conclusions:
Our findings demonstrate that developing an integrated ambulatory care model with infusion capacity for refractory pediatric headache is feasible, and our early outcomes suggest this may have a favorable impact on the overall value of care for this population.
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