• Article
  • June 12, 2017

Strategies to Reduce Hospitalizations and Emergency Visits for Children with Medical Complexities

This is the fourth 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, Wolfson Children's Hospital.

"Our kids are really sick," says Jeff Goldhagen, M.D., M.P.H., CARE project director at Wolfson Children's Hospital in Jacksonville, Florida. "We screen children prior to entering into our program to ensure they are the children who really are the priority for us to see." On average, Wolfson Children's has a higher proportion of patients in the highest acuity grouping compared to other programs with claims data to date.

Today, there are more than 600 patients enrolled in the CARE program that is centered at the 5-year-old Bower Lyman Center for Medically Complex Children. The Center is a collaboration between University of Florida-Jacksonville and Wolfson Children's Hospital and cares for children from birth through age 26.

This is the core of a system of care that includes the Complex Care Clinic (birth through 18 years) and Jacksonville Health and Transition Services program (16 to 26 years). The system also includes a community-based palliative care team, a perinatal program and an inpatient pain and palliative care consulting service that are part of Community PedsCare—a program of Community Hospice and Palliative Care.

Positive outcomes

Since the beginning of the CARE program, Wolfson Children's has experienced an improvement in a number of metrics. According to the hospital:

  • The average number of emergency department (ED) visits per CARE-enrolled patient has dropped from 0.15 per month to 0.09 per month
  • The total number of ED visits for the CARE-enrolled population fell by 38 percent
  • The average number of hospitalizations per CARE-enrolled patient has declined from 0.10 per month to 0.05 per month

"We attribute these improvements in part to the implementation of comprehensive care coordination and other elements of the CARE change concepts," Goldhagen says. "We anticipated the program would improve the metrics we hoped it would—and in fact, we've been able to demonstrate it has. This is particularly true, for children who are co-managed by our community-based palliative care program partner, Community PedsCare."

Words of advice

Goldhagen shares some advice for other institutions looking to improve, or even begin, their own program for caring for medically complex pediatric patients:

  • Obtain executive support. It's critical to secure administrative support when building such a program. Goldhagen cites the support of Wolfson Children's Hospital President Michael Aubin as "instrumental" to the program's success.
  • Build a system of care. All venues of the health system should be integrated into a comprehensive system of care to ensure children receive a fully integrated continuum of care through their medical home, hospital and community.
  • Bring passion and commitment. Only a complete commitment to the process will yield the desired results when caring for this patient population.
  • Access the electronic medical record (EMR). It is "tremendously important" to have 24/7 EMR access available at any point a patient may receive care in order to effectively and efficiently provide proper care.

About the CARE Award

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. 

Send questions or comments to magazine@childrenshospitals.org.

Read other CARE hospital case studies.

This publication was made possible by Award Number 1C1CMS331335-01-00 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies. Pub # 3154, Approved 5/24/17