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McHale L, Siddique R, Gienapp AJ, Bagwell T. A Descriptive Analysis: Infants Presenting to the Pediatric Emergency Department With a Brief Resolved Unexplained Event. Pediatr Emerg Care 2024; 40:169-174. [PMID: 38416650 DOI: 10.1097/pec.0000000000003140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
OBJECTIVES Infants presenting to pediatric emergency departments (EDs) after a choking episode, cyanotic event, or irregular breathing pattern are often diagnosed with a brief, resolved, unexplained event (BRUE). Social determinants of health may affect these patients; therefore, we aimed to define population demographics and determine significant demographic predictors between 2 cohorts-infants presenting with BRUE, and those admitted to the intensive care unit. METHODS Using data from the Pediatric Health Information System (Children's Hospital Association, Washington, DC, Lenexa, KS), this multicenter, retrospective study included children aged 0-1 year from 52 hospitals who presented with an International Classification of Diseases-10 coded primary diagnosis for BRUE/apparent life-threatening event (ALTE) between January 1, 2016, and June 30, 2021. Cohort 1 patients presented to the ED with BRUE; cohort 2 patients were admitted from the ED for BRUE. Univariate and multivariate logistic regression were performed for both cohorts to discover possible demographic predictors. RESULTS Overall, 24,027 patients were evaluated. Patient sex did not affect admission rates (odds ratio [OR] = 1.034; 95% confidence interval [CI], 0.982-1.089; P = 0.2051). Black race (OR = 1.252; 95% CI, 1.177-1.332; P < 0.0001) and Medicaid insurance (OR = 1.126; 95% CI, 1.065-1.19; P < 0.0001) were significantly associated with an increased risk of admission. "Other" race (OR = 0.837; 95% CI, 0.777-0.902; P < 0.0001) and commercial insurance were significantly associated with a greater likelihood of discharge (OR = 0.888; 95% CI, 0.84-0.939; P < 0.0001). CONCLUSIONS Black race and Medicaid insurance predicted admission in this patient population, but demographics did not play a role in intensive care unit admission overall. Social determinants of health and demographics therefore appeared to play a role in admission for patients presenting to the ED. Future research could evaluate the effect of focused interventions, such as providing additional resources to socially at-risk families through community outreach, on admission rates of patients with these specific at-risk demographics.
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Affiliation(s)
| | - Rumana Siddique
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN
| | - Andrew J Gienapp
- Children's Foundation Research Institute, Le Bonheur Children's Hospital, Memphis, TN
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Carlson KM, Berman SK, Price J. Guiding Principles for Managed Care Arrangements for the Health of Newborns, Infants, Children, Adolescents and Young Adults. Pediatrics 2022; 150:188583. [PMID: 35909156 DOI: 10.1542/peds.2022-058396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 11/24/2022] Open
Abstract
Managed care arrangements are an approach to health care delivery in which the payer or other health care entity has policies that affect where care is delivered, what services are covered, and how payment is determined. When policies are intentionally designed, transparently administered, and continuously monitored, they are more likely to improve the population's utilization of services, access to quality primary and specialty care, and access to appropriate medications. When managed care arrangements are designed well, particularly within evolving payment models, health care can be delivered in a manner that supports the goals of the Quadruple Aim: to reduce per capita costs of health care, to improve the health of populations, to improve the experience of patients receiving care, and to improve the experience of those who are providing care. The American Academy of Pediatrics (AAP) urges payers and health care entities to use the key principles outlined in this statement when designing and implementing managed care arrangements and policies that cover newborn infants, infants, children, adolescents, and young adults to support the goal of improving the effectiveness of the health care delivery system for the pediatric population. The principles described in this statement are intended to complement those previously published in other AAP policies including "Principles of Child Health Care Financing," "Scope of Health Care Benefits for Children From Birth Through Age 26," "Patient- and Family-Centered Care and the Pediatrician's Role," and the "AAP Access Principles."
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Affiliation(s)
| | | | - Jonathan Price
- Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
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Carter HE, Waugh J, Chang AB, Shelton D, David M, Weir KA, Levitt D, Carty C, Frakking TT. Cost-Effectiveness of Care Coordination for Children With Chronic Noncomplex Medical Conditions: Results From a Multicenter Randomized Clinical Trial. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:S1098-3015(22)02063-0. [PMID: 35871140 DOI: 10.1016/j.jval.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 05/02/2022] [Accepted: 06/03/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To assess the cost-effectiveness of care coordination, compared with standard care, for children with chronic noncomplex medical conditions. METHODS A total of 81 children aged between 2 and 15 years newly diagnosed with a noncomplex chronic condition were randomized to either care coordination or standard care as part of a multicenter randomized controlled trial. Families receiving care coordination were provided access to an Allied Health Liaison Officer, who facilitated family-centered healthcare access across hospital, education, primary care, and community sectors. Costs were estimated over a 12-month period from the perspective of the Australian health system. Health outcomes were valued as quality-adjusted life-years (QALYs). Caregiver productivity costs were included in an alternative base-case analysis, and key assumptions were tested in a series of one-way sensitivity analyses. A probabilistic sensitivity analysis was conducted to investigate the overall impact of uncertainty in the data. RESULTS Children in the intervention arm incurred an average of $17 in additional health system costs (95% confidence interval -3861 to 1558) and gained an additional 0.031 QALYs (95% confidence interval -0.29 to 0.092) over 12 months, producing an incremental cost-effectiveness ratio of $548 per QALY. When uncertainty was considered, there was a 73% likelihood that care coordination was cost-effective from a health system perspective, assuming a willingness to pay of $50 000 per QALY. This increased to 78% when caregiver productivity costs were included. CONCLUSIONS Care coordination is likely to be a cost-effective intervention for children with chronic noncomplex medical conditions in the Australian healthcare setting.
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Affiliation(s)
- Hannah E Carter
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, QLD, Australia.
| | - John Waugh
- Department of Paediatrics, Caboolture Hospital, Queensland Health, Caboolture, QLD, Australia; School of Clinical Medicine, The University of Queensland, Herston, QLD, Australia
| | - Anne B Chang
- Department of Respiratory Medicine, Queensland Children's Hospital, South Brisbane, QLD, Australia; Child Health Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia; Australian Centre for Health Services Innovation, Queensland University of Technology, South Brisbane, QLD, Australia
| | - Doug Shelton
- Department of Paediatrics, Gold Coast University Hospital, Queensland Health, Southport, QLD, Australia
| | - Michael David
- School of Medicine and Dentistry, Griffith University, Gold Coast, QLD, Australia; The Daffodil Centre, The University of Sydney, A Joint Venture With Cancer Council NSW
| | - Kelly A Weir
- School of Health Sciences and Social Work and Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; Allied Health Research, Gold Coast Health, Southport, QLD, Australia
| | - David Levitt
- Department of Paediatrics, Queensland Children's Hospital, Children's Health Queensland, South Brisbane, QLD, Australia
| | - Christopher Carty
- Research Development Unit, Caboolture Hospital, Queensland Health, Caboolture, QLD, Australia; Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Thuy T Frakking
- Research Development Unit, Caboolture Hospital, Queensland Health, Caboolture, QLD, Australia; Centre for Clinical Research, School of Medicine, The University of Queensland, Herston, QLD, Australia; Speech Pathology Department, Gold Coast University Hospital, Southport, QLD, Australia
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Abstract
PURPOSE OF REVIEW The aim of this study was to summarize emerging elements of paediatric alternative payment models (APMs), identify strategies to address barriers in implementing paediatric APMs and share policy approaches. RECENT FINDINGS The unique health needs of children and adolescents must be considered as paediatric value-based care and APMs are developed. The longer time period for achieving cost savings, relatively few existing model tests and challenges with cross-sector data-sharing and pooled financing are barriers to the adoption of paediatric APMs. The Integrated Care for Kids (InCK) model and some state-based efforts are testing whether an integrated service delivery model combined with paediatric APMs can reduce expenditures and improve care and outcomes. However, the relative paucity of models makes it difficult to identify the most effective strategies and overall impact of paediatric APMs. SUMMARY Emerging paediatric APMs include the following key elements: developmentally appropriate approaches, paediatric-specific quality and cost measures, a focus on primary care, special considerations for children with complex healthcare needs and cross-sector integration of data, workforce and financing. A variety of strategies, rooted in cross-sector partnerships, can be pursued to address implementation barriers and ultimately support paediatric care transformation.
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Affiliation(s)
- Daniella Gratale
- National Office of Policy and Prevention, Nemours Children's Health, Washington, District of Columbia, USA
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Kusma JD, Cartland J, Davis MM. State-Level Managed Care Penetration in Medicaid and Rates of Preventive Care Visits for Children. Acad Pediatr 2021; 21:1338-1344. [PMID: 33607329 DOI: 10.1016/j.acap.2021.02.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/01/2021] [Accepted: 02/15/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine time trends in receipt of Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services in serial cohorts of Medicaid beneficiaries <21 years, as Medicaid managed care (MMC) was adopted by states. METHODS Using annual state-level data from the Centers for Medicare & Medicaid Services, we performed national analyses of Medicaid beneficiaries <21 years from 2000 to 2017. We used generalized linear models to assess the relationship between MMC enrollment and EPSDT encounters, accounting for repeated measures, first at the national level overall and then specifying random effects at the state level. RESULTS From 2000 to 2017, there was an increase at the national level in Medicaid beneficiaries <21 years enrolled in MMC, from 65% to 94%. At the national level, for every additional 100 enrollees in MMC there was an associated increase of 36 beneficiaries with an EPSDT visit (95% confidence interval: 19-53; P < .001). When accounting for state-level variation, for every additional 100 enrollees in MMC, there was an increase of 6 beneficiaries with an EPSDT visit (95% confidence interval: 2-10; P = .003). Examining the association between MMC penetration and EPSDT participation within each state, including the 50 states and Washington DC, there were 17 states with a significant positive association between MMC ratio and EPSDT participation, and 6 states with a significant negative association. CONCLUSIONS As managed care has become the predominant form of Medicaid coverage, there has been a modest increase in preventive visits as indicated by EPSDT participation, with marked variation across states.
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Affiliation(s)
- Jennifer D Kusma
- Division of Advanced General Pediatrics and Primary Care, Mary Ann & J. Milburn Smith Child Health Research, Outreach and Advocacy Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago (JD Kusma and MM Davis), Chicago, Ill; Department of Pediatrics, Northwestern University Feinberg School of Medicine (JD Kusma, J Cartland, and MM Davis), Chicago, Ill.
| | - Jenifer Cartland
- Department of Pediatrics, Northwestern University Feinberg School of Medicine (JD Kusma, J Cartland, and MM Davis), Chicago, Ill; Data Analytics and Reporting, Ann & Robert H. Lurie Children's Hospital of Chicago (J Cartland), Chicago, Ill
| | - Matthew M Davis
- Division of Advanced General Pediatrics and Primary Care, Mary Ann & J. Milburn Smith Child Health Research, Outreach and Advocacy Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago (JD Kusma and MM Davis), Chicago, Ill; Department of Pediatrics, Northwestern University Feinberg School of Medicine (JD Kusma, J Cartland, and MM Davis), Chicago, Ill; Departments of Medicine, Medical Social Sciences, and Preventive Medicine, Northwestern University Feinberg School of Medicine (MM Davis), Chicago, Ill
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