Quantifying the benefits from a care coordination program for tracheostomy placement in neonates. (July 2020)

• Record Type: Journal Article
• Authors: Caloway, Christen; Yamasaki, Alisa; Callans, Kevin M.; Shah, Mahek; Kaplan, Robert S.; Hartnick, Christopher
• Is Part Of: International journal of pediatric otorhinolaryngology. Volume 134(2020:Jul.)
• Publication Date: 2020-07
• Subjects: Tracheostomy -- Family-centered care -- Value-based healthcare -- Time-driven activity-based costing; TDABC time-driven activity-based costing -- FCCC family care coordination program -- TCM Tracheostomy Case Manager; Otolaryngology -- Periodicals; Pediatrics -- Periodicals; Otolaryngology -- Periodicals; Pediatrics -- Periodicals; Oto-rhino-laryngologie -- Périodiques; Pédiatrie -- Périodiques; 618.9209751
• DOI: 10.1016/j.ijporl.2020.110025
• Languages: English
• ISSNs: 0165-5876

Abstract

Abstract: Objective: Value-based care models are becoming instrumental in structuring clinical care delivery in our healthcare climate. Our objective was to determine the value associated with implementation of a Family-Centered Care Coordination (FCCC) program for neonates undergoing tracheostomy. Methods: A multi-disciplinary FCCC program was implemented at the Massachusetts Eye and Ear Infirmary and MassGeneral Hospital for Children in January 2013. This program is designed to ensure a safe transition out of the hospital for children undergoing tracheostomy, reduce re-admission rates, and increase caregiver quality of life (QOL). Study participants included neonates undergoing tracheostomy in 2012 and 2015. This retrospective cohort study examined length of stay (LOS), utilized time-driven activity-based costing to estimate the cost of care, assessed caregiver QOL with 1-month Pediatric Tracheostomy Health Status Instrument (PTHSI) scores, and assessed complications with 6-month Medical Complications Associated with Pediatric Tracheostomy (MCAT) scores. Results: Following implementation of the FCCC program, average LOS decreased from 30.5 days (range 17–39) to 16.6 days (range 9–23). The largest process improvement (cost reduction of 61%) occurred in the discharge-planning phase. The overall cost per care cycle was reduced by 36%. A large clinically meaningful benefit was demonstrated for PTHSI (effect size 0.80) as well as MCAT scores (effect size 9.35). Conclusions: We demonstrated the higher outcomes, including reductions in caregiver burden and complication rates, and the lower costs associated with implementation of the FCCC program for neonates undergoing tracheostomy.