In a national project focused on improving care for children with medical complexity (CMC), quality improvement (QI) teams implemented change concepts to the care model while payment reform teams worked with payers to develop new payment models that supported the care model. The teams were successful at decreasing inpatient days, emergency department discharges, and medical spending while improving patient experience for the 8,000 enrolled children. Five of the hospitals implemented new payment models.
But sustaining these changes was a challenge; federal funding dissipated, and long-term success was dependent on each team developing an effective plan to sustain their achievements. Across the health care industry, 70% of QI projects fail to sustain long-term change, so the goal was for the new ways of working to become the norm. Over half of the CARE Award teams reported success in planning for care model sustainability.
The standardized planning approach used for this project was recognized as important to this success. This paper provides the sustainability framework for care model implementation, and shares the sustainability planning approach, participant insights, lessons learned, and results from a 12-month post-project implementation survey.
Insights relate to the process and QI work with the CMC population. The findings can be adapted to support other collaborative sustainability planning efforts in children's hospitals.