ACOs Improve Care Value For Pediatric Patients With Complex Conditions

A recent study published in Pediatrics found that development of a quality-improvement initiative through an accountable care organization (ACO) helped to improve quality and value of care for pediatric patients with complex medical conditions.

“Improving outcomes, including the value of care for children with medical complexity represents a unique and important challenge,” Garey Noritz, MD, medical director of the cerebral palsy program at Nationwide Children’s Hospital and associate professor at Ohio State University, and colleagues wrote in the study. “The extensive needs of children with medical complexity challenge traditional communication and care coordination models. Harmonizing care among multiple disciplines requires focused attention and the development of innovative approaches.”

The researchers at Nationwide Children’s Hospital developed a quality improvement initiative jointly with an affiliated ACO. The initiative targeted children with complex medical conditions—enrolling children with a percutaneous feeding tube, a neurologic condition, and Medicaid coverage. The quality improvement initiatives involved standardizing feeding tube management, providing better family education, and implementing a care coordination program.

Results from the implementation of the quality improvement initiative showed that among children studied during the study period there was a decrease of 18% in admissions and a decrease of 31.9% in the average length of stay (P < .001).  

The researchers also found that the initiative cut costs significantly. Results showed that inpatient spending decreased by $11,764,856 over the study period.

“In the setting of an ACO, in which Nationwide Children’s Hospital carried financial risk for children in our catchment area, we had robust institutional support to implement programs with the aim of improving care while reducing costs and thus improving value,” Dr Noritz and colleagues concluded. “The financial incentives for providers aligned with delivering the highest value care. This outcome is a much-needed shift in motivation for systems of health care in the United States, and we suggest that our outcomes demonstrate that ACOs can be part of the solution for improving the care of these most vulnerable children.” —David Costill