This is the second installment in a series on the CARE Award: "Coordinating All Resources Effectively." CARE is the basis of a national hallmark study aimed at improving quality outcomes and reducing costs of care for children with complex medical conditions enrolled in Medicaid. Children's Hospital Association partners with 10 of the nation's hospitals on the CARE program, which encompasses more than 8,000 patients, as well as their caregivers and health care payers.
Here, we check in with one of CARE's participating institutions, St. Joseph's Children's Hospital in Tampa, Florida.
The sentiment Daniel Plasencia shared recently with his CARE program colleagues was simple, but directly underscored the CARE study's mission. "All of these kids are important," says Plasencia, M.D., FAAP, medical director of St. Joseph's Children's Hospital. "All kids across the nation deserve good, comprehensive care for their needs."
For Plasencia and his team, "these kids" are the 566 medically complex patients of St. Joseph's Children's Hospital's Chronic-Complex Clinic—most of whom are enrolled in the CARE program.
The importance of the medical home
Plasencia describes the clinic as a "true medical home" for its patients, set up to span inpatient and outpatient needs. Longer appointment windows allow for patients with multiple medical complexities to meet with caregivers of varying specialties in one session, avoiding several separate appointments. Same-day appointments are also available. And the location of the clinic on the campus of St. Joseph's provides quick access to the emergency department, if it's necessary.
Avoiding the emergency room
One area of focus for the Chronic-Complex Clinic has been to reduce the frequency of preventable emergency room (ER) visits. A telephone triage line provides patients and their families 24/7 access to a clinic pediatrician. A provider reviews an access plan and emergency protocol with patient families, and the care team monitors and follows up on ER visits to identify patterns.
"We identify those families that are the heavy utilizers of the ER to proactively support their care needs," Plasencia says.
Those efforts have made a difference. Shortly after the clinic opened in 2001, the hospital saw a 33 percent decline in ER visits over a two-year period for its patients. Then in 2016 alone, 379 ER visits were avoided due to implementation of the access plan and emergency protocol that are a part of the CARE award QI change package.
Words of guidance
Plasencia shares advice for other institutions looking to improve, or even begin, their own program for caring for medically complex pediatric patients:
- Involve IT early. Technical support in the planning, implementation and execution of patient registries and care plans is crucial—include the IT department from the outset.
- Create an access plan. Establish a clear process for patients to navigate the care network and provide families with a 24/7 hotline.
- Leverage interns. Student interns can help with gathering patient satisfaction data, which is an important indicator of if care is improved. Plasencia says this has been vital to the progress St. Joseph's has made in quality improvement.
- Maintain consistency. Consistency among the doctors covering the clinic provides a better continuity of care and allows for the doctor to build trust with the patient and family.
In partnership with 10 of the nation's leading children's hospitals, the Children's Hospital Association received a three-year $23 million Health Care Innovation Award from the Center for Medicare and Medicaid Innovation. Of the roughly 3 million medically complex children nationwide, two-thirds are covered by Medicaid. These 2 million children represent nearly 40 percent of costs. They are clinically fragile and have intense medical and care coordination needs that are not always met by existing care delivery and payment models.
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