Pediatric Medical Home Model Cuts Neurology Costs

NEW ORLEANS – Use of a variation on the traditional medical home model for pediatric neurology cases in an underserved population led to a decrease in hospitalizations and less frequent use of the emergency department in a study that compared outcomes and health care resource utilization between the two models.

The new model also led to faster referrals and fewer broken appointments, said Dr. David Urion, director of the learning disabilities and behavioral neurology program at Children’s Hospital in Boston, who led the study.

It is already well known that access to primary care is not as great for Americans who have a lower socioeconomic status, he said. The rate of access is even lower among non-English speakers, hovering around 70%, Dr. Urion said at the annual meeting of the American Academy of Neurology.

Access to specialists is generally lower than access to primary care.

In Boston, the Community Health Center movement has tried to improve access, in part by using a medical home model. Dr. Urion and his colleagues studied two different medical home models utilized by two centers – the South End Community Health Center and the Martha Eliot Community Health Center. Both are located in predominantly Hispanic and poorer areas.

One medical home model was what would be considered "traditional," in which patients were referred by the health center to a specialist at a hospital outpatient clinic. The other was an "itinerant" model, where the specialist would hold office hours at the center on a set day of the week. Patients were referred by a primary care physician.

From 2007 to 2011, the traditional model saw about 105 patients a year, while the itinerant model had about 103 patients a year. This was the equivalent of one session per week per provider, Dr. Urion said.

For the traditional model, the median time to an appointment was 90 days. The itinerant model cut that by 76 days to a wait of only 14 days for an appointment. Only 67% of new patients kept their appointment with the traditional model, compared with 95% of those in the nontraditional model. For existing patients, only 50% kept an appointment in the traditional model, compared with 85% of those in the newer model.

The use of the emergency department was reduced 18-fold, with 1.8 visits per patient-year for the traditional model and 0.1 per patient-year for the nontraditional model. Hospitalization days per neurologic diagnosis were 0.4 days per patient-year for the traditional model, compared with 0.1 for the itinerant model.

There was a huge difference in costs. The traditional model’s charges were $14,650 per year, compared with only $1,850 for the itinerant model.

Physicians in the itinerant model also won out financially. With missed appointments and follow-ups, those in the traditional model lost $17,250 a year, compared with only $4,080 a year with the itinerant model.

Thus, the itinerant model delivered superior care, said Dr. Urion, who reported having no relevant disclosures.

NEW ORLEANS – Use of a variation on the traditional medical home model for pediatric neurology cases in an underserved population led to a decrease in hospitalizations and less frequent use of the emergency department in a study that compared outcomes and health care resource utilization between the two models.

The new model also led to faster referrals and fewer broken appointments, said Dr. David Urion, director of the learning disabilities and behavioral neurology program at Children’s Hospital in Boston, who led the study.

It is already well known that access to primary care is not as great for Americans who have a lower socioeconomic status, he said. The rate of access is even lower among non-English speakers, hovering around 70%, Dr. Urion said at the annual meeting of the American Academy of Neurology.

Access to specialists is generally lower than access to primary care.

In Boston, the Community Health Center movement has tried to improve access, in part by using a medical home model. Dr. Urion and his colleagues studied two different medical home models utilized by two centers – the South End Community Health Center and the Martha Eliot Community Health Center. Both are located in predominantly Hispanic and poorer areas.

One medical home model was what would be considered "traditional," in which patients were referred by the health center to a specialist at a hospital outpatient clinic. The other was an "itinerant" model, where the specialist would hold office hours at the center on a set day of the week. Patients were referred by a primary care physician.

From 2007 to 2011, the traditional model saw about 105 patients a year, while the itinerant model had about 103 patients a year. This was the equivalent of one session per week per provider, Dr. Urion said.

For the traditional model, the median time to an appointment was 90 days. The itinerant model cut that by 76 days to a wait of only 14 days for an appointment. Only 67% of new patients kept their appointment with the traditional model, compared with 95% of those in the nontraditional model. For existing patients, only 50% kept an appointment in the traditional model, compared with 85% of those in the newer model.

The use of the emergency department was reduced 18-fold, with 1.8 visits per patient-year for the traditional model and 0.1 per patient-year for the nontraditional model. Hospitalization days per neurologic diagnosis were 0.4 days per patient-year for the traditional model, compared with 0.1 for the itinerant model.

There was a huge difference in costs. The traditional model’s charges were $14,650 per year, compared with only $1,850 for the itinerant model.

Physicians in the itinerant model also won out financially. With missed appointments and follow-ups, those in the traditional model lost $17,250 a year, compared with only $4,080 a year with the itinerant model.

Thus, the itinerant model delivered superior care, said Dr. Urion, who reported having no relevant disclosures.

NEW ORLEANS – Use of a variation on the traditional medical home model for pediatric neurology cases in an underserved population led to a decrease in hospitalizations and less frequent use of the emergency department in a study that compared outcomes and health care resource utilization between the two models.

The new model also led to faster referrals and fewer broken appointments, said Dr. David Urion, director of the learning disabilities and behavioral neurology program at Children’s Hospital in Boston, who led the study.

It is already well known that access to primary care is not as great for Americans who have a lower socioeconomic status, he said. The rate of access is even lower among non-English speakers, hovering around 70%, Dr. Urion said at the annual meeting of the American Academy of Neurology.

Access to specialists is generally lower than access to primary care.

In Boston, the Community Health Center movement has tried to improve access, in part by using a medical home model. Dr. Urion and his colleagues studied two different medical home models utilized by two centers – the South End Community Health Center and the Martha Eliot Community Health Center. Both are located in predominantly Hispanic and poorer areas.

One medical home model was what would be considered "traditional," in which patients were referred by the health center to a specialist at a hospital outpatient clinic. The other was an "itinerant" model, where the specialist would hold office hours at the center on a set day of the week. Patients were referred by a primary care physician.

From 2007 to 2011, the traditional model saw about 105 patients a year, while the itinerant model had about 103 patients a year. This was the equivalent of one session per week per provider, Dr. Urion said.

For the traditional model, the median time to an appointment was 90 days. The itinerant model cut that by 76 days to a wait of only 14 days for an appointment. Only 67% of new patients kept their appointment with the traditional model, compared with 95% of those in the nontraditional model. For existing patients, only 50% kept an appointment in the traditional model, compared with 85% of those in the newer model.

The use of the emergency department was reduced 18-fold, with 1.8 visits per patient-year for the traditional model and 0.1 per patient-year for the nontraditional model. Hospitalization days per neurologic diagnosis were 0.4 days per patient-year for the traditional model, compared with 0.1 for the itinerant model.

There was a huge difference in costs. The traditional model’s charges were $14,650 per year, compared with only $1,850 for the itinerant model.

Physicians in the itinerant model also won out financially. With missed appointments and follow-ups, those in the traditional model lost $17,250 a year, compared with only $4,080 a year with the itinerant model.

Thus, the itinerant model delivered superior care, said Dr. Urion, who reported having no relevant disclosures.