title: Interdisciplinary pediatric aerodigestive care and reduction in health care costs and burden.
abstract: OBJECTIVE
  Children with complex respiratory and gastrointestinal disorders frequently require care from multiple pediatric subspecialists. Interdisciplinary pediatric aerodigestive clinic centers have been established at several pediatric tertiary care centers in the United States. Their effectiveness is unknown.
  
  
  OBJECTIVE
  To determine whether an interdisciplinary approach to pediatric aerodigestive disorders reduces health care costs and burden.
  
  
  METHODS
  Retrospective medical record review for the first 125 unique pediatric patients (median age, 1.51 years) seen at the Pediatric Aerodigestive Center (PAC) for aerodigestive disorders between June 2010 and August 2013 for a total of 163 outpatient clinical encounters. The PAC is an academic pediatric tertiary care center where specialists in gastroenterology, otolaryngology, pulmonology, and speech-language pathology provide interdisciplinary evaluation during a single clinic encounter and combined operative management when indicated.
  
  
  METHODS
  Interdisciplinary evaluation and treatment of pediatric aerodigestive disorders.
  
  
  METHODS
  Number of operative procedures and estimated hospital charges related to combining clinic encounters and operative procedures.
  
  
  RESULTS
  During the initial visit, each of the 125 patients received a mean (SD) of 2.9 (0.8) of a potential 4 services. Estimating per-encounter visit costs for gas, parking, and facility fees, we found that the average cost savings per family per PAC visit was $182. Evaluation under anesthesia was recommended for 85 patients (68%), resulting in 267 operative procedures performed by participating services during 158 encounters with general anesthesia. Thus, 109 episodes of anesthesia were avoided (41% reduction), reducing the risks of anesthesia and related care costs ($1985 per avoided episode).
  
  
  CONCLUSIONS
  Coordination of interdisciplinary care in the PAC resulted in a reduction of hospital charges realized through reduction in clinic- and anesthesia-related visits. Reductions in episodes of anesthesia may also reduce neurocognitive risks associated with multiple anesthetic exposures. Other nontangible benefits associated with the coordination of care, such as caregiver satisfaction, warrant further study.
authors.affiliation: Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Collaco
authors.affiliation: Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Angela D
authors.initials: AD
authors.lastname: Aherrera
authors.affiliation: Division of Pediatric Gastroenterology, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Karla J
authors.initials: KJ
authors.lastname: Au Yeung
authors.affiliation: Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Maureen A
authors.initials: MA
authors.lastname: Lefton-Greif
authors.affiliation: Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Jeannine
authors.initials: J
authors.lastname: Hoch
authors.affiliation: Department of Otolaryngology, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Skinner
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000768:Anesthesia, General; D002648:Child; D002675:Child, Preschool; D017046:Cost Savings; D017598:Efficiency, Organizational; D005260:Female; D005767:Gastrointestinal Diseases / Q000601:surgery*; D017722:Hospital Charges; D006801:Humans; D007223:Infant; D008297:Male; D008396:Maryland; D010044:Outpatient Clinics, Hospital / Q000191:economics*; D010348:Patient Care Team / Q000191:economics / Q000458:organization & administration*; D012140:Respiratory Tract Diseases / Q000601:surgery*; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000191:economics / Q000706:statistics & numerical data*; D062606:Tertiary Care Centers / Q000191:economics*; D055815:Young Adult