Integrated infusion care models may be effective for pediatric refractory headache

An integrated ambulatory care model that had infusion capacity for pediatric refractory headache appeared feasible and beneficial for these patients, according to a quality improvement study.

“Given the high cost of ED visits and inpatient hospitalizations for pediatric headache, intensive outpatient treatment of headache at infusion centers has been proposed as a potential alternative,” Hannah F.J. Shapiro, MD, of the department of neurology at Boston Children's Hospital, and colleagues wrote in Pediatric Neurology. “In addition to being less costly, use of infusion centers offers additional potential advantages, including an opportunity to develop headache services that are more integrated with multidisciplinary teams, individualized treatment plans formulated by a neurologist and streamlined care with less disruption to the patient/family's schedule.”

Despite these possible benefits, research is lacking on how to develop such integrated headache infusion care models, according to the researchers. In the current study, they aimed to outline their experience in developing the capacity for supporting an integrated pediatric headache infusion care model through an infusion center. Further, they sought to compare treatment costs in this model with that of emergency and inpatient settings.

They conducted separate analyses for encounters involving dihydroergotamine (DHE) because of the infusion’s costliness. Using run charts, the researchers tracked the number of ED visits and inpatients admissions for headache. They compared treatment efficacy between the infusion care model and the inpatient setting to serve as a balancing measure.

Compared with receiving equivalent treatments at an infusion center, results showed a 61% and a 582% mean percentage increase in cost of headache treatment receipt in the patient setting with DHE and without DHE, respectively. The researchers noted a mean percentage increase in cost of headache treatment receipt in the ED of 30% vs. equivalent treatment at an infusion center. ED visits and inpatient admissions for headache decreased following the intervention. The various settings had similar mean change in head pain.

“With rising health care costs and utilization, it is imperative to identify areas in which we can mitigate this burden,” Shapiro and colleagues wrote. “The development of integrated infusion care models for the treatment of pediatric refractory headache is feasible and may reduce health care costs by offering an alternative to ED visits and inpatient admissions.”