Howard Steven W, Zhang Zidong, Buchanan Paula, Armbrecht Eric, Williams Christine, Wilson Geneva, Hutchinson Janna, Pearson Lindsey, Ellsworth Samantha, Byler Caitlin M, Loux Travis, Wang Jing, Bernell Steph, Holekamp Nicholas
J Pediatr Health Care. 2017 Nov-Dec;31(6):634-647. doi: 10.1016/j.pedhc.2017.04.017. Epub 2017 Jun 13.
Our aim was to evaluate cost and acute care utilization related to an organized approach to care coordination and transitional care after major acute care hospitalization for children with medical complexities, including cerebral palsy.
A retrospective cohort of 32 patients from Ranken Jordan Pediatric Bridge Hospital (RJPBH) who received the Care Beyond the Bedside model was compared with 151 patients receiving standard care elsewhere across Missouri. Claims data (2007-2012) were obtained from MoHealthNet, Missouri's Medicaid program, for all children with moderate to severe cerebral palsy (defined using approximated Gross Motor Function Classification System levels) who had at least one hospital visit during the study period (N = 183). Risk-adjusted linear and Poisson regression models were used to analyze per-member-per-month costs and three indicators of acute care utilization (emergency department visits, readmissions, and inpatient days).
RJPBH patients were associated with statistically significant reductions in per-member-per-month costs (-21%), hospital readmissions (-66%), and inpatient days (-57%).
RJPBH's enhanced interprofessional medical home-like model, including intense care coordination, psychosocial therapy, family and caregiver empowerment, and transitional care, may be keys to reducing cost and unnecessary hospital use for children with medical complexities with cerebral palsy who receive Medicaid.
我们的目的是评估与一种有组织的护理协调和过渡性护理方法相关的成本和急性护理利用情况，该方法适用于患有包括脑瘫在内的复杂疾病的儿童在重大急性护理住院后的情况。
将来自兰肯·乔丹儿科过渡医院（RJPBH）的32名接受床边以外护理模式的患者的回顾性队列与密苏里州其他地方接受标准护理的151名患者进行比较。索赔数据（2007 - 2012年）来自密苏里州医疗补助计划MoHealthNet，涵盖了所有在研究期间至少有一次住院就诊的中度至重度脑瘫儿童（使用近似的粗大运动功能分类系统水平定义）（N = 183）。使用风险调整后的线性和泊松回归模型来分析每月人均成本以及急性护理利用的三个指标（急诊就诊、再入院和住院天数）。
RJPBH的患者在每月人均成本（-21%）、医院再入院率（-66%）和住院天数（-57%）方面有统计学上的显著降低。
RJPBH强化的跨专业医疗之家式模式，包括密集的护理协调、心理社会治疗、家庭和照顾者赋权以及过渡性护理，可能是降低接受医疗补助的患有复杂疾病的脑瘫儿童的成本和减少不必要的医院使用的关键。
