Quantifying the benefits from a care coordination program for tracheostomy placement in neonates

Christen Caloway; Alisa Yamasaki; Kevin M Callans; Mahek Shah; Robert S Kaplan; Christopher Hartnick

doi:10.1016/j.ijporl.2020.110025

Quantifying the benefits from a care coordination program for tracheostomy placement in neonates

Int J Pediatr Otorhinolaryngol. 2020 Jul:134:110025. doi: 10.1016/j.ijporl.2020.110025. Epub 2020 Apr 9.

Authors

Christen Caloway¹, Alisa Yamasaki², Kevin M Callans³, Mahek Shah⁴, Robert S Kaplan⁴, Christopher Hartnick⁵

Affiliations

¹ Department of Otolaryngology, Head and Neck Surgery, Rutgers New Jersey Medical School, Newark, NJ, USA.
² Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA.
³ Clinical Care Management Unit, Massachusetts General Hospital and Massachusetts Eye, Ear Infirmary, Boston, MA, USA.
⁴ Harvard Business School, Boston, MA, USA.
⁵ Department of Otolaryngology, Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA. Electronic address: christopher_hartnick@meei.harvard.edu.

PMID: 32304856
DOI: 10.1016/j.ijporl.2020.110025

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.

Keywords: Family-centered care; Time-driven activity-based costing; Tracheostomy; Value-based healthcare.

MeSH terms

Adaptation, Psychological
Caregivers / psychology
Continuity of Patient Care / organization & administration*
Continuity of Patient Care / statistics & numerical data
Cost-Benefit Analysis
Female
Health Care Costs / statistics & numerical data*
Health Status
Humans
Infant, Newborn
Length of Stay / economics
Length of Stay / statistics & numerical data
Male
Massachusetts
Patient Discharge / economics
Patient Discharge / statistics & numerical data
Patient-Centered Care / organization & administration*
Patient-Centered Care / statistics & numerical data
Postoperative Complications / economics
Postoperative Complications / epidemiology
Postoperative Complications / prevention & control
Quality Improvement / organization & administration
Quality Improvement / statistics & numerical data
Quality of Life / psychology
Retrospective Studies
Tracheostomy* / education
Tracheostomy* / psychology