The Effect of a Comprehensive Care Transition Model on Cost and Utilization for Medically Complex Children With Cerebral Palsy.

INTRODUCTION

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.

METHODS

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).

RESULTS

RJPBH patients were associated with statistically significant reductions in per-member-per-month costs (-21%), hospital readmissions (-66%), and inpatient days (-57%).

DISCUSSION

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.