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Boesch RP. Instrumental swallowing studies for the prevention of pulmonary morbidity in children and the importance of multi-disciplinary teams. J Pediatr (Rio J) 2024:S0021-7557(24)00070-6. [PMID: 38821487 DOI: 10.1016/j.jped.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2024] Open
Affiliation(s)
- R Paul Boesch
- Mayo Clinic, Division of Pediatric Pulmonology, Rochester, MN, USA.
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Pottorff A, Liu E, Du M, Catacora A, Rosen R, McSweeney M. Assessment of families' experience with care integration within an aerodigestive program. J Pediatr Gastroenterol Nutr 2024; 78:223-230. [PMID: 38374563 DOI: 10.1002/jpn3.12108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 11/06/2023] [Accepted: 11/20/2023] [Indexed: 02/21/2024]
Abstract
OBJECTIVES The objective of this study was to assess if enrollment in a pediatric multidisciplinary aerodigestive program significantly impacted families' experiences with care integration. METHODS A previously validated 48-question Pediatric Integrated Care Survey (PICS) was administered in a cross-sectional manner to both new (new-ADC) and established (est-ADC) patients presenting for an outpatient Aerodigestive Center visit at Boston Children's Hospital. Survey results were grouped into the following five care coordination domains: (1) access to care, (2) care goal creation/planning, (3) family impact, (4) communication with health care providers, and (5) team functioning. Families were asked to rate their care integration experiences in the prior 12 months using yes/no and Likert-based questions. Comparisons were analyzed using logistic regression. Factor analysis was also performed. RESULTS Ninety patient families were surveyed: 54 (60%) est-ADC patients and 36 (40%) new-ADC patients. Est-ADC patients reported higher levels of experience with team functioning, provider awareness of prior testing, provider communication, and access to alternative methods of communication. Self-identified non-White patients reported lower satisfaction in team functioning and provider understanding of their child's long-term care plan. No significant differences in care integration experiences before and after the onset of the coronavirus pandemic were seen. CONCLUSIONS Patients enrolled in aerodigestive centers experienced improved care integration, most significantly in provider communication and team functioning. Despite these improvements, self-identified non-White families reported a lower care integration experience.
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Affiliation(s)
- Alexandra Pottorff
- Division of Gastroenterology, Hepatology and Nutrition, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Enju Liu
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Maritha Du
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Andrea Catacora
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Rachel Rosen
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Maireade McSweeney
- Division of Gastroenterology, Hepatology, and Nutrition, Boston Children's Hospital, Boston, Massachusetts, USA
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Rees M, Collins CE, Majellano EC, McDonald VM. Healthcare Professionals' Perspectives of Nonsurgical Care of Older Inpatients with Class II or III Obesity and Comorbidities: A Qualitative Study. J Multidiscip Healthc 2023; 16:3339-3355. [PMID: 38024134 PMCID: PMC10640832 DOI: 10.2147/jmdh.s421520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 09/08/2023] [Indexed: 12/01/2023] Open
Abstract
Background Older people with Class II or III obesity and comorbidities experience complex care needs with frequent hospital admissions. In 2019/20 the National Health Service in England reported a 17% increase in hospital admissions of patients with obesity compared to 2018/19. Gaps in care for this population have been identified. Purpose The purpose of this study was to understand the experiences and perspectives of healthcare professionals delivering non-surgical care to older people with Classes II or III obesity admitted to a tertiary care hospital. Methods Healthcare professionals delivering non-surgical care to older people admitted with Class II or III obesity with comorbidities were recruited from an Australian tertiary referral hospital. Qualitative semi-structured interviews were conducted with 24 healthcare professionals from seven disciplines between August and December 2019. The interviews were audio-recorded, transcribed, and reviewed by participants for accuracy. Thematic inductive data analysis was deductively mapped to the Theoretical Domains Framework (TDF). Results Four major themes of Barriers, Facilitators, Current Practice, and Recommendations and 11 subthemes were identified and mapped to nine domains in the TDF. The Barriers subtheme identified perceived patient related factors, health system issues, and provider issues, while the Facilitators subtheme included a patient centred approach, knowledge, and resources in the subacute setting. The major Current Practice theme explored factors influencing clinical management, and the Recommendations subthemes included engaging patients, access to quality care, education and support, and obesity as a chronic disease. Conclusion This novel application of the TDF provided broad insights related to the barriers and facilitators in delivering non-surgical care to this hospital population, from the perspective of healthcare professionals. Understanding how these barriers interact can provide strategies to influence behaviour change and assist in the development of a holistic multidisciplinary model of care.
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Affiliation(s)
- Merridie Rees
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
| | - Clare E Collins
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
- Food and Nutrition Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
| | - Eleanor C Majellano
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
- Medical and Interventional Services, Hunter New England Local Health District, Newcastle, NSW, Australia
| | - Vanessa M McDonald
- College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW, Australia
- Asthma and Breathing Research Program, Hunter Medical Research Institute, Newcastle, NSW, Australia
- Medical and Interventional Services, Hunter New England Local Health District, Newcastle, NSW, Australia
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Brinkmeier J, Al-Hammadi N, Shashidhar S, Hinyard L, Patel D. Characterization of combined endoscopies and aerodigestive care: An analysis of utilization and financial feasibility. PLoS One 2023; 18:e0291179. [PMID: 37672547 PMCID: PMC10482277 DOI: 10.1371/journal.pone.0291179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/23/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND Aerodigestive care is one model of multi-disciplinary care, which is a valuable tool for both providers and patients. Aerodigestive care models are associated with improved outcomes, reduced anesthesia exposure, reduction in hospital admissions, and fewer days of missed work or school. This is the first study to explore national usage and cost trends in combined endoscopy utilization to identify gaps in care and the potential for financial resource optimization. METHODS Data from the Healthcare Cost and Utilization Project (HCUP) Kid's Inpatient Sample (KID) was used from 2016 and 2019. Diagnoses and procedures were identified using ICD-10 codes, for patients with hospital length of stay less than 1 day. Demographic data were identified, and survey-weighted means and proportions were computed. Bivariate comparisons were made using Rao Scott Chi-Square tests. National estimates of charges were computed with discharge weights, developed using the American Hospital Association (AHA) universe. KEY RESULTS White, high-income patients, and those at urban teaching hospitals received the greatest proportion of combined endoscopic procedures. The cost/charges associated with combined endoscopies are less than for separate gastrointestinal (GI) or airway only endoscopies combined. However, combined procedures comprise a smaller share of national aggregate cost. CONCLUSIONS National utilization trends highlight racial and socioeconomic disparities and suggest differences in access based on hospital characteristics, despite the reduced cost/charges of the combined procedure. For patients with a need for combined aerodigestive procedures, there appears to be a cost-savings opportunity to increase efforts for combined procedures at the level of the clinician or hospital.
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Affiliation(s)
- Jennifer Brinkmeier
- Division of Pediatric Otolaryngology, Department of Otolaryngology, Washington University & Saint Louis Children’s Hospital, St. Louis, MO, United States of America
- Advanced HEAlth Data (AHEAD) Institute, Saint Louis University School of Medicine, St. Louis, MO, United States of America
| | - Noor Al-Hammadi
- Advanced HEAlth Data (AHEAD) Institute, Saint Louis University School of Medicine, St. Louis, MO, United States of America
- Department of Health and Clinical Outcomes Research, Saint Louis University, Saint Louis, MO, United States of America
| | - Sumana Shashidhar
- Saint Louis University School of Medicine, St. Louis, MO, United States of America
| | - Leslie Hinyard
- Advanced HEAlth Data (AHEAD) Institute, Saint Louis University School of Medicine, St. Louis, MO, United States of America
- Department of Health and Clinical Outcomes Research, Saint Louis University, Saint Louis, MO, United States of America
| | - Dhiren Patel
- Advanced HEAlth Data (AHEAD) Institute, Saint Louis University School of Medicine, St. Louis, MO, United States of America
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Cardinal Glennon Children’s Medical Center, Saint Louis University School of Medicine, St. Louis, MO, United States of America
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Kaspy KR, Burg G, Garrison AP, Miller CK, Pentiuk S, Smith MM, Benscoter D. The follow up of complex infants in an aerodigestive clinic. Paediatr Respir Rev 2022; 44:3-10. [PMID: 36411238 DOI: 10.1016/j.prrv.2022.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/28/2022] [Indexed: 12/17/2022]
Abstract
The current available literature evaluating pediatric multidisciplinary aerodigestive programs for the management of aerodigestive disorders in infants was reviewed. Multidisciplinary aerodigestive programs have emerged to provide coordinated and comprehensive care for the growing population of children with aerodigestive conditions, including complex airway, pulmonary, gastrointestinal, and feeding disorders, which are prevalent among infants discharged from the neonatal intensive care unit (NICU). The team approach central to aerodigestive clinics offers a comprehensive diagnostic workup and unified management plan through consolidated interdisciplinary clinics, combined endoscopic procedures, and regular team discussions, leading to improved resource utilization and health care outcomes. We review common conditions presenting in the NICU that benefit from the aerodigestive model of care, including esophageal atresia, prematurity, bronchopulmonary dysplasia with or without tracheostomy or ventilator dependence, and dysphagia.
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Affiliation(s)
- Kimberley R Kaspy
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Gregory Burg
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA.
| | - Aaron P Garrison
- Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Claire K Miller
- Aerodigestive and Esophageal Center, Division of Speech-Language Pathology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Scott Pentiuk
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA; Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | - Matthew M Smith
- Division of Pediatric Otolaryngology Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Dan Benscoter
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA; Department of Pediatrics, University of Cincinnati, Cincinnati, OH, USA
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Taha MB, Rao N, Vaduganathan M, Cainzos-Achirica M, Nasir K, Patel KV. Implementation of Cardiometabolic Centers and Training Programs. Curr Diab Rep 2022; 22:203-212. [PMID: 35316465 DOI: 10.1007/s11892-022-01459-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE OF REVIEW Type 2 diabetes is frequently accompanied by obesity, nonalcoholic fatty liver disease, chronic kidney disease, and cardiovascular disease, which collectively contribute to the high burden of cardiometabolic disease. This review discusses cardiometabolic disease management, strategies to implement cardiometabolic centers to deliver care, and dedicated programs to train the next generation of cardiometabolic experts. RECENT FINDINGS Sodium-glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and a nonsteroidal mineralocorticoid receptor antagonist have demonstrated beneficial effects across cardiometabolic conditions. However, utilization of effective pharmacotherapies is low in clinical practice, in part due to clinical inertia and traditional sharp delineation in clinical responsibilities of specialists. Multidisciplinary clinics and population-health models can provide comprehensive care but require investment in physical and information technology infrastructure as well as in training and accreditation. Post-internal medicine residency cardiometabolic health training programs have been proposed. Implementing cardiometabolic centers in health systems involves reshaping current practices. Training programs focused on cardiometabolic health are needed to address the growing burden of disease and specific training needs in this ever-expanding area.
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Affiliation(s)
- Mohamad B Taha
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, Houston, TX, 77030, USA
| | - Neha Rao
- Department of Medicine, Houston Methodist Hospital, Houston, TX, USA
| | - Muthiah Vaduganathan
- Division of Cardiovascular Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Miguel Cainzos-Achirica
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, Houston, TX, 77030, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, Houston, TX, 77030, USA
- Center for Outcomes Research, Houston Methodist, Houston, TX, USA
| | - Kershaw V Patel
- Division of Cardiovascular Prevention and Wellness, Department of Cardiology, Houston Methodist DeBakey Heart & Vascular Center, 6550 Fannin St Suite 1801, Houston, TX, 77030, USA.
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Volner K, Montgomery AS, Gould C, Lustik M, Liming B. Aerodigestive clinic reduces emergency department and primary care utilization and increases access to ancillary and specialty care. Int J Pediatr Otorhinolaryngol 2022; 154:111059. [PMID: 35149370 DOI: 10.1016/j.ijporl.2022.111059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 11/14/2021] [Accepted: 01/25/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The study aimed to evaluate the effect of the aerodigestive clinic (ADC) on healthcare utilization. STUDY DESIGN Retrospective quality improvement project; before and after. SETTING The ADC at Tripler Army Medical Center (TAMC) in Honolulu, HI. METHODS We retrospectively analyzed the electronic medical records of children ≤17 years old seen in the ADC at TAMC between April 2015 and June 2019. The number of emergency department (ED), primary care (PC), specialty care (SC), ancillary care (AC), and teleconsult (TC) encounters were tallied before and after one year of the initial intake visit. RESULTS A total of 261 children were included during the study period. Comparing visits before aerodigestive evaluation to after aerodigestive evaluation, the total number of visits before and after were similar with significant changes in the distribution of encounters. The total number of ED (-38%) and PC (-40%) visits decreased significantly (p < 0.001 for both). The total number of other visits were found to have non-significant increases. PC visits accounted for nearly one-third (31%) of all visits prior to the initial ADC visit, but only 19% of visits after. PC visits decreased for all age groups. ED visits decreased by nearly half (-48.1%) for ages 1-17, but there was no change for <1-year olds. CONCLUSION There is a statistically significant reduction in the number of emergency department and primary care visits for patients seen in a multidisciplinary ADC. The distribution of visits differed strongly among age groups. These findings emphasize the positive impact that the multidisciplinary clinic has on healthcare utilization for pediatric aerodigestive patients.
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Affiliation(s)
- Keith Volner
- Otolaryngology Head and Neck Surgery, Tripler Army Medical Center Honolulu, Hawaii, USA.
| | - Agnes S Montgomery
- Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI, USA
| | - Christine Gould
- Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI, USA
| | - Michael Lustik
- Department of Clinical Investigations, Tripler Army Medical Center, Honolulu, HI, USA
| | - Bryan Liming
- Otolaryngology Head and Neck Surgery, Madigan Army Medical Center, Tacoma, WA, USA
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Villegas MA, Okenfuss E, Savarirayan R, White K, Hoover-Fong J, Bober MB, Duker A, Legare JM. Multidisciplinary Care of Neurosurgical Patients with Genetic Syndromes. Neurosurg Clin N Am 2021; 33:7-15. [PMID: 34801144 DOI: 10.1016/j.nec.2021.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Neurosurgical patients with genetic syndromes often receive care from multidisciplinary teams. Successful models range from multiple providers in one clinic space seeing a patient together to specialists located at different institutions working together. Collaboration and bidirectional communication are key. Multidisciplinary care improves outcomes and patient satisfaction. Choosing the goal of the clinic, using ancillary staff, and obtaining institutional buy-in are important initial first steps to establishing a multidisciplinary team clinic. Multidisciplinary teams can leverage technology to expand care via telehealth in multidisciplinary clinics and more vitally communication between providers on the team.
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Affiliation(s)
- Melissa A Villegas
- University of Wisconsin School of Medicine and Public Health, 1500 Highland Avenue, Madison, WI 53705, USA
| | - Ericka Okenfuss
- Department of Genetics, Kaiser Permanente of Northern California, 1650 Response Road Kaiser, Sacramento, CA 95815, USA
| | - Ravi Savarirayan
- Victorian Clinical Genetics Services, Murdoch Children's Research Institute and University of Melbourne, Parkville, Victoria 3052, Australia
| | - Klane White
- Seattle Children's, 4800 Sand Point Way, OA.9.120, Seattle, WA 98105, USA
| | - Julie Hoover-Fong
- Greenberg Center for Skeletal Dysplasias, McKusick Nathans Department of Genetic Medicine, Johns Hopkins University, 600 N. Wolfe Street, Blalock 1008, Baltimore, MD 21287, USA
| | - Michael B Bober
- A.I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA
| | - Angela Duker
- A.I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE 19803, USA
| | - Janet M Legare
- University of Wisconsin School of Medicine and Public Health, 1500 Highland Avenue, Madison, WI 53705, USA.
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Wolfe KR, Hutaff-Lee C, Wilkening G. Neuropsychological Screening in Pediatric Multidisciplinary Clinics: Group Characteristics and Predictive Utility. Arch Clin Neuropsychol 2021; 37:789-797. [PMID: 34747436 DOI: 10.1093/arclin/acab090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility of administering caregiver-report neuropsychological screening measures in pediatric multidisciplinary clinics (MDCs) and investigate predictive utility for cognitive and academic difficulties on follow-up testing. METHOD The Pediatric Perceived Cognitive Functioning (Peds PCF) and Colorado Learning Difficulties Questionnaire (CLDQ) were administered to caregivers of youth with history of brain tumor (BT), non-central nervous system (CNS) cancer, or Fontan circulation as part of routine neuropsychological consultation in MDCs from 2017 to 2019. We examined cross-sectional differences on screening measures, and relationships between screening and intellectual and academic test performance in a subset who presented for follow-up neuropsychological evaluation. Receiver operating characteristic (ROC) curve analysis was used to identify suggested cut scores on screening measures for predicting who would most benefit from further evaluation. RESULTS Screening was completed with 192 families. Children with history of non-CNS cancer (n = 29) had fewer parent-reported cognitive and academic concerns compared with either BT (n = 88) or Fontan (n = 75) groups. Peds PCF and CLDQ scores were related to intellectual and academic test performance in the group presenting for neuropsychological evaluation (n = 68). ROC curve analysis identified cut scores across screening measures with maximal sensitivity and specificity for detecting neuropsychological difficulties. CONCLUSIONS It is feasible to utilize parent rating measures during neuropsychological consultation in pediatric MDCs. The Peds PCF and CLDQ demonstrated sensitivity to intellectual and academic difficulties in children with significant medical histories. Screening may be a helpful tool for pediatric neuropsychologists and other professionals during MDC consultation to inform clinical management.
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Affiliation(s)
- Kelly R Wolfe
- Section of Neurology, Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Christa Hutaff-Lee
- Section of Neurology, Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Greta Wilkening
- Section of Neurology, Department of Pediatrics, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
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How to manage children who aspirate and fail conventional treatments. OTOLARYNGOLOGY CASE REPORTS 2021. [DOI: 10.1016/j.xocr.2021.100314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Davis MJ, Luu BC, Raj S, Abu-Ghname A, Buchanan EP. Multidisciplinary care in surgery: Are team-based interventions cost-effective? Surgeon 2021; 19:49-60. [PMID: 32220537 DOI: 10.1016/j.surge.2020.02.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/28/2020] [Accepted: 02/21/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Multidisciplinary care has been shown to improve outcomes for patients, and interprofessional collaboration has been demonstrated to be beneficial for providers. In the field of surgery, although a large number of multidisciplinary care teams have been described, no study to date has examined whether or not these team-based interventions are generally cost-effective. This is the first systematic review to examine cost savings attributable to multidisciplinary care across all surgical fields. METHODS A comprehensive literature review of articles published on cost outcomes associated with multidisciplinary surgical teams was performed. Selected articles reported on cost outcomes directly attributable to a collaborative intervention. Cost savings were totaled on a per-patient basis. Each article was also reviewed to determine whether the authors ultimately recommended the team-based intervention described. RESULTS A total of 1421 articles were identified in the initial query, of which 43 met inclusion criteria. Thirty-nine studies (91%) reported multidisciplinary care to be cost effective, with an average cost savings among all studies of $5815 per patient. No significant differences in the amount of savings achieved were found between different intervention subtypes. All studies ultimately recommended (40) or gave mixed reviews (3) of multidisciplinary care, regardless of whether cost savings were achieved. CONCLUSION Multidisciplinary surgical care is beneficial not only in terms of patient and provider outcomes, but also in reference to its cost-effectiveness. Well-designed multidisciplinary teams tend to optimize perioperative care for all involved parties. Efforts to improve surgical care should employ multidisciplinary teams to promote both quality and cost-effective care.
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Affiliation(s)
- Matthew J Davis
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Bryan C Luu
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Sarth Raj
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Amjed Abu-Ghname
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, USA
| | - Edward P Buchanan
- Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA; Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, TX, USA.
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Fuladi A, Suresh S, Thomas R, Wong M, Schilling S, Ee L, Choo K, Bourke C, McBride C, Masters BI, Kapur N. Multidisciplinary approach to paediatric aerodigestive disorders: A single-centre longitudinal observational study. J Paediatr Child Health 2020; 56:1929-1932. [PMID: 32886957 DOI: 10.1111/jpc.15090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 12/25/2022]
Abstract
AIM Aerodigestive clinics (ADCs) are multidisciplinary programmes for the care of children with complex congenital or acquired conditions affecting breathing, swallowing and growth. Our objective was to describe the demographic, clinical, etiological and investigational profile of children attending the inaugural ADC at a tertiary paediatric centre in Queensland. METHODS Children referred to the ADC at Queensland Children's Hospital from August 2018 to December 2019 were included. Data on clinical, growth and lung function parameters, bronchoscopy and upper gastrointestinal endoscopy findings, thoracic imaging and comorbidities were retrospectively analysed. RESULTS Fifty-six children (median (range) age 4 years (3 months-15 years); 18 female) attended the ADC during this 17-month period. Forty-six (82%) children had previous oesophageal atresia with tracheo-oesophageal fistula; 43 of these were type C. Previous isolated oesophageal atresia, congenital diaphragmatic hernia and congenital pulmonary malformation were the underlying disorder in three (5%) children each, with one child having a repaired laryngeal cleft. Vertebral Anal Tracheo Esophageal Renal Limb anomalies (VACTERL)/Vertebral Anal Tracheo Esophageal renal anomalies (VATER) association was seen in 21 (38%) children. Growth was adequate (median weight and body mass index z-score -0.63 and -0.48, respectively). Thirty-four (61%) children reported ongoing wet cough, with 12 (21%) requiring previous hospital admission for lower respiratory tract infection. Fourteen (25%) had bronchiectasis on computed tomography chest and 33 (59%) had clinical tracheomalacia, apparent on bronchoscopic examination in 21 patients. Dysphagia was reported in 15 (27%) children, 11 (20%) were gastrostomy feed-dependent and 5 (9%) had biopsy-proven eosinophilic oesophagitis. CONCLUSION High proportion of children attending the ADC have ongoing respiratory symptoms resulting in chronic pulmonary suppuration and bronchiectasis. Potential benefits of this model of care need to be studied prospectively to better understand the outcomes.
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Affiliation(s)
- Amol Fuladi
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Sadasivam Suresh
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Rahul Thomas
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Matthew Wong
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Sandra Schilling
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Looi Ee
- Department of Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Kelvin Choo
- Department of Paediatric Surgery, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Christopher Bourke
- Department of Paediatric Surgery, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Craig McBride
- Department of Paediatric Surgery, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Brent I Masters
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Nitin Kapur
- Department of Respiratory and Sleep Medicine, Queensland Children's Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
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Style CC, Hsu DM, Verla MA, Mittal AG, Austin P, Seth A, Dietrich JE, Adeyemi-Fowode OA, Bercaw-Pratt JL, Chiou EH, Chumpitazi BP, Akalonu A, Victorian VA, Denner FR, Borden AN, Levitt MA, Grooms JR, Frazier GG, Rialon KL, Lee TC. Development of a multidisciplinary colorectal and pelvic health program: Program implementation and clinical impact. J Pediatr Surg 2020; 55:2397-2402. [PMID: 32471759 DOI: 10.1016/j.jpedsurg.2020.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/24/2020] [Accepted: 05/03/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Pediatric patients with complex colorectal and genitourinary conditions often require coordinated multidisciplinary care; however, this coordinated care can be hard to structure and deliver. The purpose of this paper is to review the development and implementation of a multidisciplinary colorectal and pelvic health program, one year after the program's initiation. METHODS This is an observational retrospective 1-year study (10/1/2017 to 9/30/2018). In fiscal year (FY) 2018, a multidisciplinary colorectal and pelvic health program was initiated. The program development incorporated bimonthly team meetings, educational conferences, and initiation of three clinics: a complex colorectal and genitourinary reconstruction clinic, a bowel management clinic, and a colonic motility clinic. Conditions treated included complex anorectal and cloacal malformations, Hirschsprung disease, and idiopathic constipation. The fiscal year was selected to provide comparative administrative data after program implementation. RESULTS During the study period, 121 patients underwent comprehensive collaborative evaluation of which 58 (47%) were new to the institution compared to 12 (19%) new patients in the previous year (p < 0.001). In FY 2018, there were 130 procedures performed and 512 collaborative visits with an average of 47 visits per month. This was a 3.4-fold increase in visits compared to FY2017 (171 visits). Of the new patients, 60% (35/58), traveled a median of 181 miles, representing 33 statewide counties, and 4 states compared to a median of 93 miles in the previous fiscal year (p = 0.004). CONCLUSION The development of a colorectal and pelvic health program is feasible and requires a collaborative approach, necessitating multiple service lines within an institution. Program creation and implementation can result in rapid institutional clinical growth by filling a local and regional need through coordinated multidisciplinary care. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Candace C Style
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Danielle M Hsu
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Mariatu A Verla
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Angela G Mittal
- Division of Urology, Baylor College of Medicine, Houston, TX
| | - Paul Austin
- Division of Urology, Baylor College of Medicine, Houston, TX
| | - Abhishek Seth
- Division of Urology, Baylor College of Medicine, Houston, TX
| | - Jennifer E Dietrich
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Oluyemisi A Adeyemi-Fowode
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Jennifer L Bercaw-Pratt
- Division of Pediatric and Adolescent Gynecology, Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX
| | - Eric H Chiou
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Houston, TX
| | - Bruno P Chumpitazi
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Houston, TX
| | - Amaka Akalonu
- Department of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Houston, TX
| | | | - Felicia R Denner
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | | | - Marc A Levitt
- Center for Colorectal and Pelvic Reconstruction, Nationwide Children's Hospital, Columbus, OH
| | - Jag R Grooms
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Gia G Frazier
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Kristy L Rialon
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX
| | - Timothy C Lee
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX; Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
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Koumbourlis AC, Belessis Y, Cataletto M, Cutrera R, DeBoer E, Kazachkov M, Laberge S, Popler J, Porcaro F, Kovesi T. Care recommendations for the respiratory complications of esophageal atresia-tracheoesophageal fistula. Pediatr Pulmonol 2020; 55:2713-2729. [PMID: 32716120 DOI: 10.1002/ppul.24982] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/18/2020] [Accepted: 07/22/2020] [Indexed: 12/11/2022]
Abstract
Tracheoesophageal fistula (TEF) with esophageal atresia (EA) is a common congenital anomaly that is associated with significant respiratory morbidity throughout life. The objective of this document is to provide a framework for the diagnosis and management of the respiratory complications that are associated with the condition. As there are no randomized controlled studies on the subject, a group of experts used a modification of the Rand Appropriateness Method to describe the various aspects of the condition in terms of their relative importance, and to rate the available diagnostic methods and therapeutic interventions on the basis of their appropriateness and necessity. Specific recommendations were formulated and reported as Level A, B, and C based on whether they were based on "strong", "moderate" or "weak" agreement. The tracheomalacia that exists in the site of the fistula was considered the main abnormality that predisposes to all other respiratory complications due to airway collapse and impaired clearance of secretions. Aspiration due to impaired airway protection reflexes is the main underlying contributing mechanism. Flexible bronchoscopy is the main diagnostic modality, aided by imaging modalities, especially CT scans of the chest. Noninvasive positive airway pressure support, surgical techniques such as tracheopexy and rarely tracheostomy are required for the management of severe tracheomalacia. Regular long-term follow-up by a multidisciplinary team was considered imperative. Specific templates outlining the elements of the clinical respiratory evaluation according to the patients' age were also developed.
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Affiliation(s)
- Anastassios C Koumbourlis
- Division of Pulmonary & Sleep Medicine, Children's National Hospital, George Washington University School of Medicine & Health Sciences, Washington, District of Columbia
| | - Yvonne Belessis
- Department of Respiratory Medicine, Sydney Children's Hospital Randwick, Randwick, New South Wales, Australia
| | - Mary Cataletto
- Division of Pediatric Pulmonary Medicine, New York University, Winthrop University Hospital, Mineola, New York
| | - Renato Cutrera
- Academic Department of Pediatrics (DPUO), Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long Term Ventilation Unit, Pediatric Hospital "Bambino Gesù" Research Institute, Rome, Italy
| | - Emily DeBoer
- Department of Pediatrics, Section of Pulmonary and Sleep Medicine, University of Colorado Denver, Children's Hospital Colorado Breathing Institute, Aurora, Colorado
| | - Mikhail Kazachkov
- Department of Pediatric Pulmonology, Gastroesophageal, Upper Airway and Respiratory Diseases Center, New York University School of Medicine, New York, New York
| | - Sophie Laberge
- Department of Pediatrics, Division of Respiratory Medicine, Sainte-Justine University Hospital Center, Université de Montréal, Montreal, Quebec, Canada
| | - Jonathan Popler
- Division of Pediatric Pulmonology, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Federica Porcaro
- Department of Pediatrics, Pediatric Pulmonology & Respiratory Intermediate Care Unit, Sleep and Long-Term Ventilation Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Thomas Kovesi
- Pediatrics, Division of Respirology, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
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15
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Yibrehu BA, Krakovsky GM, Rana MS, Pillai DK, Sehgal S, Collins ME, Gatti ML, Bauman NM. Pediatric Quality-of-Life Scores Following a Multidisciplinary Aerodigestive Team Approach to Manage Chronic Cough. Ann Otol Rhinol Laryngol 2020; 129:1088-1094. [PMID: 32486883 DOI: 10.1177/0003489420931558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Chronic recalcitrant cough is present in 2/3 of pediatric patients evaluated in our tertiary-care multidisciplinary aerodigestive clinic (ADC). This study aimed to determine the impact of chronic cough and efficacy of ADC treatment using the validated Pediatric-Cough Quality-of-Life-27 tool (PC-QOL-27). METHODS The PC-QOL-27 survey was administered to ADC patients with chronic cough at initial clinic visit and 6 to 12 weeks after cough management. Pre and post survey scores, demographic data, treatment and evaluation season were collected over 16 months. RESULTS Twenty parents completed pre and post PC-QOL-27 surveys (mean 12.1 weeks later). Patient median age was 6.04 years (IQR: 2.2-10.44 years). A total of 65% were males and 65% were African American. Management was tailored based on clinical assessment and diagnostic studies, including direct laryngoscopy/bronchoscopy (4), pulmonary function tests (PFT's 9), esophagogastroduodenoscopy (9), and flexible bronchoscopy/lavage (9).Following ADC management, changes in physical, social and psychological domain scores of the PC-QOL-27 each met the threshold for minimal clinical important difference (MCID) indicating a clinically meaningful improvement. Improvements were most notable in the physical domain where post survey scores significantly improved from pre-survey scores (P = .009) regardless of age, gender, ethnicity, history of endoscopy and season. CONCLUSIONS The physical impact of chronic cough in pediatric patients who failed prior management by a single specialist was lessened by an ADC team approach to management.
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Affiliation(s)
- Betel A Yibrehu
- George Washington University School of Medicine, Washington, DC, USA
| | | | - Md Sohel Rana
- Children's National Health System, Washington, DC, USA
| | - Dinesh K Pillai
- George Washington University School of Medicine, Washington, DC, USA.,Children's National Health System, Washington, DC, USA
| | - Sona Sehgal
- George Washington University School of Medicine, Washington, DC, USA.,Children's National Health System, Washington, DC, USA
| | | | | | - Nancy M Bauman
- George Washington University School of Medicine, Washington, DC, USA.,Children's National Health System, Washington, DC, USA
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16
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Wootten CT, Belcher R, Francom CR, Prager JD. Aerodigestive Programs Enhance Outcomes in Pediatric Patients. Otolaryngol Clin North Am 2019; 52:937-948. [DOI: 10.1016/j.otc.2019.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Ruiz AG, Bhatt JM, DeBoer EM, Friedlander J, Janosy N, Peterson MB, Wine T, Deterding R, Prager JD. Demonstrating the benefits of a multidisciplinary aerodigestive program. Laryngoscope 2019; 130:521-525. [DOI: 10.1002/lary.27939] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 02/01/2019] [Accepted: 02/27/2019] [Indexed: 12/28/2022]
Affiliation(s)
- Amanda G. Ruiz
- Department of Pediatric OtolaryngologyUniversity of Colorado School of Medicine and Children's Hospital Colorado Aurora Colorado U.S.A
| | - Jay M. Bhatt
- Department of Pediatric OtolaryngologyUniversity of Colorado School of Medicine and Children's Hospital Colorado Aurora Colorado U.S.A
| | - Emily M. DeBoer
- Department of Pediatrics–Section of Pulmonary MedicineUniversity of Colorado School of Medicine and Children's Hospital Colorado Aurora Colorado U.S.A
| | - Joel Friedlander
- Department of Pediatrics–Section of Gastroenterology, Hepatology, and NutritionUniversity of Colorado School of Medicine and Children's Hospital Colorado Aurora Colorado U.S.A
| | - Norah Janosy
- Department of Pediatric AnesthesiologyUniversity of Colorado School of Medicine and Children's Hospital Colorado Aurora Colorado U.S.A
| | - Melissa Brooks Peterson
- Department of Pediatric AnesthesiologyUniversity of Colorado School of Medicine and Children's Hospital Colorado Aurora Colorado U.S.A
| | - Todd Wine
- Department of Pediatric OtolaryngologyUniversity of Colorado School of Medicine and Children's Hospital Colorado Aurora Colorado U.S.A
| | - Robin Deterding
- Department of Pediatrics–Section of Pulmonary MedicineUniversity of Colorado School of Medicine and Children's Hospital Colorado Aurora Colorado U.S.A
| | - Jeremy D. Prager
- Department of Pediatric OtolaryngologyUniversity of Colorado School of Medicine and Children's Hospital Colorado Aurora Colorado U.S.A
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18
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Straughan AJ, Mudd PA, Silva AL, Callicott SS, Krakovsky G, Bauman NM. Cost Analysis of a Multidisciplinary Vascular Anomaly Clinic. Ann Otol Rhinol Laryngol 2019; 128:401-405. [DOI: 10.1177/0003489419826135] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: Multidisciplinary vascular anomaly clinics (VACs) offer important value to pediatric patients with complex vascular anomalies whose care overlaps specialties. These clinics are labor intensive and costly to operate since providers see fewer patients compared to their individual specialty clinic. Our North American tertiary care institution’s VAC specialists include a pediatric otolaryngologist, pediatric surgeon, pediatric plastic surgeon, pediatric dermatologist, and interventional radiologist. To assess financial feasibility, we conducted a cost analysis of our VACs comprised of 2 half-day multidisciplinary physician attended clinics (5 specialists at our main campus and 2 specialists at a satellite clinic) and a half-day nurse practitioner clinic. Method: Assessment of net revenue based on net collections for clinic, professional, operative, hospital setting, and facility charges generated during 12 consecutive monthly VACs beginning July 1, 2015. Expense calculations included provider and staff salaries, benefits, supply costs, and clinic leasing costs. Results: There were 469 clinic visits, of which 202 were new patient evaluations. Sixty-eight patients underwent 93 procedures under general anesthesia, including procedures performed by our interventional radiologist, most commonly sclerotherapy or embolization (n = 37), surgical interventions including endoscopy (n = 36), or laser procedures (n = 20). Three patients were admitted. Fifty-seven patients received a new diagnosis different from that for which they were referred. Gross revenue was $1 810 525, and net revenue was 42.5%, or $783 152. Expenses totaled $453 415 for a net positive revenue of $329 737. Conclusion: When including direct downstream revenue, particularly from operative procedures, our VAC program operates on a net positive margin, making the program financially feasible.
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Affiliation(s)
| | - Pamela A. Mudd
- Children’s National Health System, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
| | | | | | | | - Nancy M. Bauman
- Children’s National Health System, Washington, DC, USA
- George Washington University School of Medicine, Washington, DC, USA
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Naime S, Batra SK, Fiorillo C, Collins ME, Gatti M, Krakovsky GM, Sehgal S, Bauman NM, Pillai DK. Aerodigestive Approach to Chronic Cough in Children. ACTA ACUST UNITED AC 2018; 4:467-479. [PMID: 30859056 DOI: 10.1007/s40746-018-0145-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose of review Chronic cough is the most common presenting complaint in a pediatric aerodigestive clinic. The etiology of chronic cough is varied and often includes more than one organ system. This review aims to summarize the current literature for a multidisciplinary approach when evaluating a child with chronic cough. Recent findings There is very little medical literature focused on a multidisciplinary approach to chronic cough. In the limited data available, multidisciplinary clinics have been shown to be more cost-efficient for the families of children with complex medical problems, and also increase the likelihood of successfully obtaining a diagnosis. Summary There is no consensus in the literature on how to work-up a child with chronic cough presenting to an aerodigestive clinic. Current studies from these clinics have shown improved outcomes related to cost-effectiveness and identifying definitive diagnoses. Future studies evaluating clinical outcomes are necessary to help delineate the utility of testing routinely performed, and to demonstrate the impact of interventions from each specialty on quality of life and specific functional outcome measures.
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Affiliation(s)
- Samira Naime
- Department of Pulmonary and Sleep Medicine, Children's National Health System, Washington, DC, USA.
| | - Suruchi K Batra
- Department of Gastroenterology, Hepatology, and Nutrition, Children's National Health System, Washington, DC, USA.
| | - Caitlin Fiorillo
- Department of Otolaryngology-Head and Neck Surgery, Children's National Health System, Washington, DC, USA.
| | - Maura E Collins
- Department of Hearing and Speech, Children's National Health System, Washington, DC, USA.
| | - Meagan Gatti
- Department of Pulmonary and Sleep Medicine, Children's National Health System, Washington, DC, USA.
| | - Gina M Krakovsky
- Department of Otolaryngology-Head and Neck Surgery, Children's National Health System, Washington, DC, USA.
| | - Sona Sehgal
- Department of Gastroenterology, Hepatology, and Nutrition, Children's National Health System, Washington, DC, USA.
| | - Nancy M Bauman
- Department of Otolaryngology-Head and Neck Surgery, Children's National Health System, Washington, DC, USA.
| | - Dinesh K Pillai
- Department of Pulmonary and Sleep Medicine, Children's National Health System, Washington, DC, USA
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20
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Abstract
INTRODUCTION Laryngotracheal stenosis comprises a broad spectrum of congenital and acquired conditions that commonly cause pediatric airway obstruction. Although the majority of these conditions were historically managed with endoscopic dilations, the introduction of operative procedures such as laryngotracheoplasty, cricotracheal resection, and slide tracheoplasty changed the treatment paradigm. The gradual evolution of endoscopic technology enabled surgeons to perform certain procedures endoscopically that were previously only able to be performed in an open fashion. Areas covered: This review highlights the important aspects of the diagnosis, workup, and surgical treatment of pediatric laryngotracheal stenosis. Important articles describing research and techniques within pediatric airway reconstruction are summarized and included in the review. Expert commentary: The importance of the multidisciplinary concept of treating laryngotracheal stenosis is evidenced by the establishment of aerodigestive centers internationally. In order to continue successfully treating complex cases of laryngotracheal stenosis, further airway research is needed. The application and feasibility of tracheal transplantation and replacement is likely the next frontier in the treatment of laryngotracheal stenosis.
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Affiliation(s)
- Matthew M Smith
- a Division of Pediatric Otolaryngology-Head and Neck Surgery , Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA.,b Department of Otolaryngology-Head and Neck Surgery , University of Cincinnati College of Medicine , Cincinnati , OH , USA
| | - Robin T Cotton
- a Division of Pediatric Otolaryngology-Head and Neck Surgery , Cincinnati Children's Hospital Medical Center , Cincinnati , OH , USA.,b Department of Otolaryngology-Head and Neck Surgery , University of Cincinnati College of Medicine , Cincinnati , OH , USA
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