HOUSTON - (Dec. 23, 2014) - High-risk children with chronic illness who received comprehensive care at a special clinic staffed by physicians and nurse practitioners from The University of Texas Health Science Center at Houston (UTHealth), had a dramatic reduction in serious illnesses as documented in a study published in the December 24/31 issue of JAMA. These benefits are the greatest identified to date for medical homes for patients in any age group.
The High Risk Children's Clinic is an enhanced medical home that is part of UT Physicians, the clinical practice of UTHealth Medical School. It provides both primary and subspecialty care with an emphasis on promoting prompt, effective care at all hours.
The researchers randomly assigned 201 high-risk children with chronic illness to receive comprehensive care, which included treatment from primary care clinicians and specialists in the High Risk Children's Clinic, or usual care provided locally in private offices or faculty-supervised clinics.
Comprehensive care - or enhanced medical home - compared to usual care, reduced the number of children with a serious illness by 55 percent and total hospital and clinic costs to $16,523 from $26,781 per child per year. Rates were also reduced by 48 to 69 percent for emergency department visits, hospitalizations, number of days in the hospital, intensive care unit (ICU) admissions and days in the ICU. Parent satisfaction was also greatly enhanced.
"We knew we could improve outcomes for the patients," said Ricardo A. Mosquera, M.D., first author, assistant professor of pediatrics at UTHealth Medical School and director of the clinic. "But we didn't realize that it would have such a significant impact and cost difference. Long-term, it helped a lot of children and saved a lot of money."
Patients were defined as high-risk with chronic illness if they had three or more emergency department visits, two or more hospitalizations, or one or more pediatric intensive care unit admissions during the previous year, and a greater than 50 percent estimated risk for hospitalization. Although the patient-centered or family-centered medical home is widely recommended, its value in improving clinical outcomes or reducing health care costs had not been previously demonstrated in clinical trials in children with chronic illnesses or in any group of adults.
Medical homes are potentially the most cost-effective for high-risk patients, particularly high-risk children with chronic illness whose care is often fragmented, costly and ineffective.
Most children with chronic illnesses severe enough to quality for this comprehensive care program are enrolled in Medicaid. However, current Medicaid reimbursements do not come close to covering the costs of this program of care even though it substantially reduces overall health system costs. A major problem is that without adequate Medicaid reimbursements, institutions that have the expertise to provide such care programs will be unable to implement or sustain them.
Senior author is Jon Tyson, M.D., M.P.H., the Michelle Bain Distinguished Professor of Medicine and Public Health and vice dean for Clinical Research & Healthcare Quality at UTHealth. UTHealth co-authors include Elenir B.D. Avritscher, M.D., Ph.D.; Cheryl L. Samuels, R.N., P.N.P.; Tomika S. Harris, R.N., P.N.P., D.N.P.; Claudia Pedroza, Ph.D.; Fernando Navarro, M.D.; Susan H. Wootton, M.D.; Susan Pacheco, M.D.; Shade Moody, M.D.; and Luisa Franzini, Ph.D.. Other co-authors are Guy Clifton, M.D.; Patricia Evans, M.D.; and John Zupancic, M.D., Sc.D.
The study was initially supported by the UTHealth and subsequently funded in part by the Centers for Medicare & Medicaid Services (1C1MS331044-01-00), Texas Health and Human Services and the National Center for Advancing Translational Sciences (5 UL1TR00371).
JAMA contributed to this press release