Complex Care

toddSpring 2012Leave a Comment

Nicholas Camferdam (with his parents Rob and Allison Camferdam).

Nicholas Camferdam (with his parents Rob and Allison Camferdam) receives coordinated care for his complex medical conditions at Arkansas Children's Hospital.

By Susan Van Dusen

The dream of every expectant parent is a healthy child. However, for some families this dream is interrupted by the reality of health conditions that require costly long-term therapies.

“Thanks to recent medical advances, children who would have died just 10 years ago now survive and are able to live at home with their families. This has caused us to look at new and innovative ways to manage the care of these children, many of whom have multiple, chronic medical conditions,” said Patrick Casey, M.D., Harvey & Bernice Jones Professor of Developmental Pediatrics in the UAMS College of Medicine.

Out of that concern for coordinated care was born the Medical Home Clinic for Special Needs Children at Arkansas Children’s Hospital (ACH). Staffed by physicians in the UAMS Department of Pediatrics, the Medical Home Clinic has garnered national attention for its progressive approach to care for medically complex children, even earning praise from U.S. Health and Human Services Secretary Kathleen Sebelius for its cost-saving efforts.

Since its inception in 2006, the clinic has served more than 800 children from across Arkansas. Children in the program have at least two serious, chronic illnesses and see at least two subspecialists.

“Our goal is to improve the health care these children receive while also cutting costs by avoiding hospitalization,” said Casey, whose serves as co-medical director of the clinic with Robert Lyle, M.D., UAMS professor of pediatrics and co-medical director of the Neonatal Intensive Care Unit at ACH.

The clinic is structured on the “medical home” concept, which was taking shape across the country when the clinic was established. “Our definition of a medical home is an integrated, interdisciplinary and coordinated system of clinical care that allows us to collect data on its outcomes,” said Richard Jacobs, M.D., chairman of the UAMS Department of Pediatrics.

Each patient in the clinic continues to see his or her primary care physician as well as all needed subspecialists. The clinic staff includes pediatricians, nurses, nutritionists, social workers, speech pathologists and child psychologists. At least one person from each discipline is present for each clinic visit, ensuring continuity of care.

Each child also is assigned a nurse coordinator who is available for daytime telephone consultations on concerns of any kind, including appointment coordination, clinical decision making and acute care issues.

“Before we opened the Medical Home Clinic, I would see families drive up to three hours multiple times a week so their child could see our specialists. Now we coordinate these visits into one day so the stress and expense on these families is reduced,” Lyle said.

An article published in the May 2011 issue of Pediatrics and Adolescent Medicine outlined the cost savings in the clinic’s first years. The savings for Medicaid per patient per year was $14,148 for the first year after the initial clinic contact. For the 225 patients included in the study, that total annual savings was more than $3.1 million. This was a result, in large part, of reduced number of hospitalizations and shorter lengths of stay.

“The program has shown that it’s possible to provide coordinated care for complex children in a nurturing environment while demonstrating measurable outcomes and cost savings,” Jacobs said.

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