title: A Population Intervention to Improve Outcomes in Children With Medical Complexity.
abstract: Children with medical complexity experience frequent interactions with the medical system and often receive care that is costly, duplicative, and inefficient. The growth of value-based contracting creates incentives for systems to improve their care. This project was designed to improve the health, health care value, and utilization for a population-based cohort of children with neurologic impairment and feeding tubes.
  
  
  
  A freestanding children's hospital and affiliated accountable care organization jointly developed a quality improvement initiative. Children with a percutaneous feeding tube, a neurologic diagnosis, and Medicaid, were targeted for intervention within a catchment area of >300 000 children receiving Medicaid. Initiatives included standardizing feeding tube management, improving family education, and implementing a care coordination program.
  
  
  
  Between January 2011 and December 2014, there was an 18.0% decrease (P < .001) in admissions and a 31.9% decrease (P < .001) in the average length of stay for children in the cohort. Total inpatient charges were reduced by $11 764 856. There was an 8.2% increase (P < .001) in the percentage of children with weights between the fifth and 95th percentiles. The care coordination program enrolled 58.3% of the cohort.
  
  
  
  This population-based initiative to improve the care of children with medical complexity showed promising results, including a reduction in charges while improving weight status and implementing a care coordination program. A concerted institutional initiative, in the context of an accountable care organization, can be part of the solution for improving outcomes and health care value for children with medical complexity.
authors.affiliation: Nationwide Children's Hospital, Columbus, Ohio; garey.noritz@nationwidechildrens.org.|Department of Pediatrics, The Ohio State University, Columbus, Ohio; and.|Partners For Kids, Columbus, Ohio.
authors.forename: Garey
authors.initials: G
authors.lastname: Noritz
authors.affiliation: Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Melissa
authors.initials: M
authors.lastname: Madden
authors.affiliation: Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: Dina
authors.initials: D
authors.lastname: Roldan
authors.affiliation: Nationwide Children's Hospital, Columbus, Ohio.
authors.forename: T Arthur
authors.initials: TA
authors.lastname: Wheeler
authors.affiliation: Nationwide Children's Hospital, Columbus, Ohio.|Partners For Kids, Columbus, Ohio.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Conkol
authors.affiliation: Nationwide Children's Hospital, Columbus, Ohio.|Department of Pediatrics, The Ohio State University, Columbus, Ohio; and.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Brilli
authors.affiliation: Nationwide Children's Hospital, Columbus, Ohio.|Department of Pediatrics, The Ohio State University, Columbus, Ohio; and.
authors.forename: John
authors.initials: J
authors.lastname: Barnard
authors.affiliation: Nationwide Children's Hospital, Columbus, Ohio.|Department of Pediatrics, The Ohio State University, Columbus, Ohio; and.|Partners For Kids, Columbus, Ohio.
authors.forename: Sean
authors.initials: S
authors.lastname: Gleeson
mesh_terms: D060866:Accountable Care Organizations / Q000191:economics / Q000458:organization & administration*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003284:Contract Services / Q000191:economics / Q000458:organization & administration*; D017046:Cost Savings / Q000191:economics; D004750:Enteral Nutrition / Q000191:economics; D005260:Female; D006776:Hospitals, Pediatric / Q000191:economics / Q000458:organization & administration; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D007902:Length of Stay / Q000191:economics; D008297:Male; D008329:Managed Care Programs / Q000191:economics / Q000458:organization & administration; D008484:Medicaid / Q000191:economics / Q000458:organization & administration*; D009422:Nervous System Diseases / Q000191:economics / Q000628:therapy*; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000191:economics; D058996:Quality Improvement / Q000191:economics / Q000458:organization & administration*; D014481:United States; D000070376:Value-Based Health Insurance / Q000191:economics / Q000458:organization & administration*; D062505:Value-Based Purchasing / Q000191:economics / Q000458:organization & administration*