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Enhanced medical homes decrease illnesses and costs among children

Enhanced medical homes that provide comprehensive care reduced serious illness and costs for high-risk children with chronic illnesses, according to a recently published study.

“The benefits and cost savings we identified with comprehensive care seem likely to be achievable only in high-risk populations treated in major academic centers with the subspecialists, resources and clinician commitment to provide such care,” Ricardo A. Mosquera, MD, of the department of pediatrics at the University of Texas, Houston, told Healio Family and Internal Medicine.

Ricardo A. Mosquera

Mosquera and colleagues performed a randomized clinical trial of high-risk children with chronic illnesses who were treated with either usual care (n=96) at a private office or at an enhanced medical home (n=105) (a high-risk clinic at the University of Texas) between March 2011 and February 2013. They included children with high health care use and estimated risk of hospitalization.

The rate of children with a serious illness (10 per 100 child-years vs. 22 in usual care, RR=0.45; 95% CI, 0.28-0.73) and overall hospital and clinic costs ($16,523 vs. $26.781 per child/year) decreased with comprehensive care. They found a 97% chance of comprehensive care being either cost neutral or cost saving.

Comprehensive care was shown to reduce serious illnesses (RR=0.33; 95% CI, 0.17-0.66), ED visits (RR=0.48; 95% CI, 0.34-0.67), hospitalizations (RR=0.51; 95% CI, 0.33-0.77), pediatric ICU admissions (RR=0.35; 95% CI, 0.18-0.70) and number of days in a hospital (RR=0.36; 95% CI, 0.19-0.67). Medicaid costs decreased $6,243 per child-year, and medical school losses went up $6,018 per child-year, according to the researchers.

Mosquera recommended the following for physicians in clinical settings:

• Allot extra time for a comprehensive examination at every visit for patients with complex chronic conditions.
• Inform yourself about your patients’ conditions.
• Maintain continuous contact with chronically ill patients.
• Establish good relationships with specialists in the area to call if you have questions or need advice.
• Follow-up with patients that have had recent ED visits and hospitalizations to coordinate care.

“[These] are important take home lessons for every clinician that can be applied to every clinical setting,” Mosquera said.

Disclosure: The researchers report receiving support from the University of Texas Health Science Center at Houston and grants from Texas Health and Human Services and the National Center for Advancing Translational Sciences. See the study for a full list of the researchers’ relevant financial disclosures.