title: Effect of hospital-based comprehensive care clinic on health costs for Medicaid-insured medically complex children.
abstract: OBJECTIVE
  To evaluate the effect on all state Medicaid costs of a children's hospital-based multidisciplinary clinic that provides comprehensive and coordinated care for medically complex children.
  
  
  METHODS
  Before-after intervention study. Patients' health care costs for up to 1 year before enrollment in the clinic were compared with patients' health care costs for up to 1 year after enrollment in the clinic. Patients were enrolled in our study from August 2006 to May 2008.
  
  
  METHODS
  Tertiary care children's hospital in a rural state.
  
  
  METHODS
  A total of 225 medically complex children who had at least 2 chronic medical conditions and who were followed up by at least 2 pediatric subspecialists.
  
  
  METHODS
  Multidisciplinary teams ensure that each patient receives all the necessary medical, nutritional, and developmental care and that there is improved coordination of care with primary care providers, subspecialists, hospitalists, and community-based services.
  
  
  METHODS
  Using Arkansas Medicaid claims data, we examined the medical costs for all outpatient, inpatient, emergency department, and prescription drug claims. Costs were calculated on a per month per patient basis and summarized for annual costs.
  
  
  RESULTS
  The mean annual cost per patient per month decreased by $1766 for inpatient care (P < .001) and by $6.00 for emergency department care (P < .001). Although the cost per patient per month for outpatient claims (P < .05) and prescriptions (P < .001) increased, the overall cost to Medicaid per patient per month decreased by $1179 (P < .001).
  
  
  CONCLUSIONS
  This hospital-based multidisciplinary clinic resulted in a significant decrease in total Medicaid costs for medically complex children.
authors.affiliation: Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR 72202, USA. caseypatrickh@uams.edu
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Casey
authors.forename: Robert E
authors.initials: RE
authors.lastname: Lyle
authors.forename: Tommy M
authors.initials: TM
authors.lastname: Bird
authors.forename: James M
authors.initials: JM
authors.lastname: Robbins
authors.forename: Dennis Z
authors.initials: DZ
authors.lastname: Kuo
authors.forename: Carrie
authors.initials: C
authors.lastname: Brown
authors.forename: Arti
authors.initials: A
authors.lastname: Lal
authors.forename: Aline
authors.initials: A
authors.lastname: Tanios
authors.forename: Katherine
authors.initials: K
authors.lastname: Burns
mesh_terms: D000553:Ambulatory Care / Q000191:economics*; D001131:Arkansas; D002671:Child, Exceptional; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D017048:Health Care Costs; D006776:Hospitals, Pediatric / Q000458:organization & administration; D006801:Humans; D007223:Infant; D008297:Male; D008484:Medicaid / Q000191:economics*; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D012424:Rural Population; D014481:United States