Mercy Clinic Department of Pediatrics, St. Louis, Missouri, USA.
Imagine Pediatrics, Nashville, Tennessee, USA.
Telemed J E Health. 2023 Jun;29(6):947-953. doi: 10.1089/tmj.2022.0344. Epub 2022 Nov 10.
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 () utilization and charges before implementation and during the 2-year program. Eighty ( = 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 ( = 0.0268), a 43.9% reduction in emergency visits ( = 0.0005), and a 16.9% reduction in overall charges ( = 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 visits for this high-cost population. Further economic evaluation is needed to determine sustainability of this model in a value-based payment system.
患有复杂疾病的儿童和青少年受益于护理协调和专门的儿科护理，但存在许多获得护理的障碍。我们实施了虚拟综合护理模式，为患有复杂疾病的儿童及其家庭提供支持，并使用经济框架来衡量结果。确定患有复杂疾病的儿童并将其纳入虚拟复杂护理计划，该计划有一个专门的多学科团队，提供护理协调、教育、父母支持、急性护理分诊和虚拟就诊。通过对来自医院行业数据研究所（HIDI）数据库的数据进行回顾性预分析和后分析，衡量实施前和 2 年计划期间的住院、门诊和急诊就诊的利用情况和费用。80 名（=80 名）儿童纳入经济评估，其中 75 名儿童有足够的数据进行分析。与入组前 12 个月相比，患者的住院率降低了 35.3%（=0.0268），急诊就诊率降低了 43.9%（=0.0005），总费用降低了 16.9%（=0.1449）。家长的满意度很高，回应率为 70%，满意度为 90%。我们实施了虚拟护理模式，为患有复杂疾病的儿童和青少年提供家庭支持和护理协调，并使用经济框架评估利用情况和成本的变化。该计划的参与率和家长满意度都很高，预/后分析表明，该高成本人群的住院和急诊就诊次数显著减少。需要进一步的经济评估来确定该模式在基于价值的支付系统中的可持续性。
