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Implementation and Evaluation of a Wraparound Virtual Care Program for Children with Medical Complexity
Alison L Curfman1,2, Meghan Haycraft2, S David McSwain3
1Mercy Clinic Department of Pediatrics, St. Louis, Missouri, USA.
Insights
A virtual wraparound model significantly reduced hospitalizations and emergency visits for children with medical complexity. This innovative care coordination program also demonstrated high parent satisfaction and reduced overall healthcare charges.
Area of Science:
- Pediatric healthcare delivery
- Health services research
- Digital health interventions
Background:
- Children and adolescents with medical complexity face significant access barriers to specialized care and care coordination.
- Existing healthcare models often struggle to provide integrated support for these vulnerable patients and their families.
Purpose of the Study:
- To implement and evaluate a virtual wraparound model for supporting medically complex children and adolescents.
- To measure the economic impact of this virtual care model on healthcare utilization and costs.
Main Methods:
- A retrospective pre- and post-analysis was conducted using data from the Hospital Industry Data Institute (HIDI).
- The study included 80 children with medical complexity enrolled in a virtual complex care program featuring a multidisciplinary team, care coordination, education, and virtual visits.
- Inpatient, outpatient, and emergency department (ED) utilization and charges were compared before and during the 2-year program.
Main Results:
- A statistically significant reduction in hospitalizations (35.3%) and emergency visits (43.9%) was observed post-implementation.
- Overall healthcare charges decreased by 16.9%, though this was not statistically significant.
- The program achieved high engagement rates and a 90% parent satisfaction rate among respondents.
Conclusions:
- A virtual care model can effectively provide in-home support and care coordination for medically complex pediatric populations.
- The implemented program demonstrated significant reductions in hospitalizations and ED visits, indicating improved efficiency and potential cost savings.
- Further economic evaluation is necessary to confirm the long-term sustainability of this virtual wraparound model within value-based payment systems.
Abstract:
Children and adolescents with medical complexity benefit from care coordination and specialized pediatric care, but many access barriers exist. We implemented a virtual wraparound model to support patients with medical complexity and their families and used an economic framework to measure outcomes. Children with medical complexity were identified and enrolled in a virtual complex care program with a dedicated multidisciplinary team, which provided care coordination, education, parental support, acute care triage, and virtual visits. A retrospective pre- and postanalysis of data obtained from the Hospital Industry Data Institute (HIDI) database measured inpatient, outpatient, and emergency department (ED) utilization and charges before implementation and during the 2-year program. Eighty (n = 80) children were included in the economic evaluation, and 75 had sufficient data for analysis. Compared to the 12 months before enrollment, patients had a 35.3% reduction in hospitalizations (p = 0.0268), a 43.9% reduction in emergency visits (p = 0.0005), and a 16.9% reduction in overall charges (p = 0.1449). Parents expressed a high degree of satisfaction, with a 70% response rate and 90% satisfaction rate. We implemented a virtual care model to provide in-home support and care coordination for medically complex children and adolescents and used an economic framework to assess changes in utilization and cost. The program had high engagement rates and parent satisfaction, and a pre/postanalysis demonstrated statistically significant reduction in hospitalizations and ED visits for this high-cost population. Further economic evaluation is needed to determine sustainability of this model in a value-based payment system.
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