Impact of a Multidisciplinary Spina Bifida Clinic on Healthcare Resource Utilization

Multidisciplinary spina bifida clinics using an integrated care model are designed to address the complex healthcare needs associated with open neural tube defects by delivering coordinated, streamlined, and comprehensive care. However, the impact of this care model on healthcare utilization patterns remains unclear, particularly among resource-limited populations. We therefore assessed the relationship between integrated care, social determinants of health, and healthcare utilization among patients with open neural tube defects, with a specific focus on unanticipated healthcare encounters.

All patients with open neural tube defects who were seen by a pediatric neurosurgeon at Connecticut Children's between January 1, 2021, and May 1, 2023 were retrospectively reviewed. Patients seen in an integrated, multidisciplinary Spina Bifida Clinic were compared to those who were evaluated exclusively in the pediatric neurosurgery clinic without concurrent multidisciplinary evaluations. Recurrent event risk of an unexpected healthcare encounter following the index routine visit was modelled with Andersen-Gill Cox proportional hazards, adjusting for demographic, social determinants of health, and select clinical factors.

Forty nine patients met the inclusion criteria. During the study period, they had a total of 326 appointments, including 196 unexpected visits. There was 1 median unexpected visit per patient (IQR 0-2.50) in the integrated cohort, compared to 3 (IQR 1-5.75) in the non-integrated cohort (p = 0.02). The emergency department (ED) was the most common setting for unexpected encounters, with 82 total visits and 65.3% of patients having at least one visit. Integrated care was associated with a 79% lower hazard of having an unexpected clinic visit (adjusted HR 0.21, 95% CI 0.09-0.51; p < 0.001), but ED visits were similar between the two cohorts.

In this preliminary analysis, engagement with a multidisciplinary spina bifida clinic was associated with a significant reduction in the risk of having an unplanned clinic encounter, highlighting integrated care as a promising strategy to curb high cost utilization in this population. Prospective multicenter studies are needed to determine the extent of this effect, determine which clinic components drive this benefit, and to evaluate cost effectiveness across diverse settings.