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

• Published in: Pediatric neurology Vol. 127; pp. 41 - 47
• Main Authors: Shapiro, Hannah F.J., Sant, Jenifer, Minster, Anna, Antonelli, Richard C.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2022
• Subjects: Adolescent; Ambulatory Care - economics; Ambulatory Care - organization & administration; Ambulatory Care - standards; Care integration; Child; Cost; Dihydroergotamine; Dihydroergotamine - administration & dosage; Dihydroergotamine - economics; Feasibility Studies; Headache; Headache Disorders - drug therapy; Humans; Infusion capacity; Models, Organizational; Pediatric; Process Assessment, Health Care; Quality Improvement; Referral and Consultation; Value; Vasoconstrictor Agents - administration & dosage; Vasoconstrictor Agents - economics; Workflow; Headache; Care integration; Value; Dihydroergotamine; Infusion capacity; Pediatric; Cost
• ISSN: 0887-8994; 1873-5150
• DOI: 10.1016/j.pediatrneurol.2021.11.012

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. 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. 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. 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.