Cost Analysis and Policy Implications of a Pediatric Palliative Care Program.

CONTEXT: In 2010, California launched Partners for Children (PFC), a pediatric palliative care pilot program offering hospice-like services for children eligible for full-scope Medicaid delivered concurrently with curative care, regardless of the child's life expectancy. OBJECTIVES: We assessed the change from before PFC enrollment to the enrolled period in 1) health care costs per enrollee per month (PEPM), 2) costs by service type and diagnosis category, and 3) health care utilization (days of inpatient care and length of hospital stay). METHODS: A pre-post analysis compared enrollees' health care costs and utilization up to 24 months before enrollment with their costs during participation in the pilot, from January 2010 through December 2012. Analyses were conducted using paid Medicaid claims and program enrollment data. RESULTS: The average PEPM health care costs of program enrollees decreased by $3331 from before their participation in PFC to the enrolled period, driven by a reduction in inpatient costs of $4897 PEPM. PFC enrollees experienced a nearly 50% reduction in the average number of inpatient days per month, from 4.2 to 2.3. Average length of stay per hospitalization dropped from an average of 16.7 days before enrollment to 6.5 days while in the program. CONCLUSION: Through the provision of home-based therapeutic services, 24/7 access to medical advice, and enhanced, personally tailored care coordination, PFC demonstrated an effective way to reduce costs for children with life-limiting conditions by moving from costly inpatient care to more coordinated and less expensive outpatient care. PFC's home-based care strategy is a cost-effective model for pediatric palliative care elsewhere.

Feasibility of school-based spirometry screening for asthma.

To determine the feasibility and value of spirometry in school-based asthma screening, spirometry testing was coupled with parent questionnaires in a school-based asthma screening project. Children in grades five to eight of the Catholic school system in Rochester, Minn., performed spirometry with coaching and data acquisition by nurses trained for this activity. Most students completed three tests. For each student, the best test was selected for interpretation. Tests were considered technically unacceptable for screening purposes if the FEV1 was less than 85% and the curve showed evidence of cough, delayed start, poor initial effort, incomplete effort, or non-reproducibility. Students with acceptable tests and FEV1 < 85% as predicted for age, race, and BMI were classified as appropriate for referral for further evaluation of potential asthma. A sensitivity analysis was conducted using different FEV1 thresholds for referral. Children (119, 17.6% of all) with known asthma based on parent-completed questionnaire were not considered for referral. Of the remaining 557 students screened, 535 had technically acceptable tests, and 498 had normal spirometry performance. Using a threshold for referral of FEV1 < 85%, 37 children were candidates for referral for further evaluation of potential asthma. Only four (11%) of these also had questionnaire responses that made them candidates for referral. School-based spirometry screening for asthma is technically feasible but there is little overlap between those who are referral candidates based on spirometry data and those who are referral candidates based on parent-reported symptoms on screening questionnaires. Without further study, spirometry cannot be recommended for school-based asthma screening.