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Shapiro HFJ, Sant J, Minster A, et al. Development and Evaluation of an Integrated Outpatient Infusion Care Model for the Treatment of Pediatric Headache. Pediatr Neurol. 2021;127:41-47doi: 10.1016/j.pediatrneurol.2021.11.012.
Shapiro, H. F. J., Sant, J., Minster, A., & Antonelli, R. C. (2021). Development and Evaluation of an Integrated Outpatient Infusion Care Model for the Treatment of Pediatric Headache. Pediatric neurology, 12741-47. https://doi.org/10.1016/j.pediatrneurol.2021.11.012
Shapiro, Hannah F J, et al. "Development and Evaluation of an Integrated Outpatient Infusion Care Model for the Treatment of Pediatric Headache." Pediatric neurology vol. 127 (2021): 41-47. doi: https://doi.org/10.1016/j.pediatrneurol.2021.11.012
Shapiro HFJ, Sant J, Minster A, Antonelli RC. Development and Evaluation of an Integrated Outpatient Infusion Care Model for the Treatment of Pediatric Headache. Pediatr Neurol. 2021 Dec 02;127:41-47. doi: 10.1016/j.pediatrneurol.2021.11.012. Epub 2021 Dec 02. PMID: 34959159.
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Pediatr Neurol. 2021 Dec 02;127:41-47. doi: 10.1016/j.pediatrneurol.2021.11.012. Epub 2021 Dec 02.

Development and Evaluation of an Integrated Outpatient Infusion Care Model for the Treatment of Pediatric Headache.

Pediatric neurology

Hannah F J Shapiro, Jenifer Sant, Anna Minster, Richard C Antonelli

Affiliations

  1. Department of Neurology, Boston Children's Hospital, Boston, Massachusetts. Electronic address: [email protected].
  2. Department of Neurology, Boston Children's Hospital, Boston, Massachusetts.
  3. Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts.

PMID: 34959159 DOI: 10.1016/j.pediatrneurol.2021.11.012

Abstract

BACKGROUND: Care for pediatric patients with headache often occurs in high-cost settings such as emergency departments (EDs) and inpatient settings. Outpatient infusion centers have the potential to reduce care costs for pediatric headache management.

METHODS: In this quality improvement study, we describe our experience in creating the capacity to support an integrated outpatient pediatric headache infusion care model through an infusion center. We compare costs of receiving headache treatment in this model with those in the emergency and inpatient settings. Because dihydroergotamine (DHE) is a costly infusion, encounters at which DHE was administered were analyzed separately. We track the number of ED visits and inpatient admissions for headache using run charts. As a balancing measure, we compare treatment efficacy between the infusion care model and the inpatient setting.

RESULTS: The mean percentage increase in cost of receiving headache treatment in the inpatient setting with DHE was 61% (confidence interval [CI]: 30-99%), and that without DHE was 582% (CI: 299-1068%) compared with receiving equivalent treatments in the infusion center. The mean percentage increase in cost of receiving headache treatment in the ED was 30% (CI: -15 to 100%) compared with equivalent treatment in the infusion center. After the intervention, ED visits and inpatient admissions for headache decreased. The mean change in head pain was similar across care settings.

CONCLUSIONS: Our findings demonstrate that developing an integrated ambulatory care model with infusion capacity for refractory pediatric headache is feasible, and our early outcomes suggest this may have a favorable impact on the overall value of care for this population.

Copyright © 2021 The Author(s). Published by Elsevier Inc. All rights reserved.

Keywords: Care integration; Cost; Dihydroergotamine; Headache; Infusion capacity; Pediatric; Value

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