TY - JOUR
T1 - Pediatric cardiomyopathy as a chronic disease
T2 - A perspective on comprehensive care programs
AU - Bublik, Natalya
AU - Alvarez, Jorge A.
AU - Lipshultz, Steven E.
N1 - Funding Information:
We interviewed six pediatric cardiologists who practice in some of the major academic medical centers across the United States (personal communication with Charles Canter, MD, Professor of Pediatrics, St. Louis Children's Hospital, Washington University School of Medicine; Steven Colan, MD, Professor of Pediatrics, Children's Hospital Boston, Harvard Medical School; Daphne T. Hsu, MD, Professor of Clinical Pediatrics, Morgan Stanley Children's Hospital of New York-Presbyterian College of Physicians & Surgeons, Columbia University; Paolo Rusconi, MD, Associate Professor of Pediatrics, Holtz Children's Hospital, Leonard M. Miller School of Medicine, University of Miami; Jeffrey A. Towbin, MD, Professor of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Steven A. Webber, MBChB, Professor of Pediatrics, Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine. September–October 2007). All interviewees reported having pediatric comprehensive heart failure programs at their institutions. These programs had been operating for 3 to 17 years. Several are financed by the patient's health insurance, and some draw their resources from the sponsoring institution. Additional resources came from non-profit organizations for one program. The components of these programs varied in terms of team composition, but they all included pediatric heart failure and heart transplant specialists. Some of the personnel were not full-time in the programs. Four of the programs routinely measured and recorded health outcomes of their patients. Only one program measured the associated costs of treatment. Although all programs published their clinical research findings, none had described the nature of their program or the overall efficacy. Three programs collected feedback from patients and families, as well as from associated medical personnel. All interviewees identified at least several important elements missing from their programs. Interview highlights are summarized in . Table 3
PY - 2008/4
Y1 - 2008/4
N2 - Substantial numbers of children with cardiomyopathy are now surviving into adulthood, making it essentially a chronic disease. As a chronic condition, it may be best treated through comprehensive, multidisciplinary treatment programs. Such programs have improved health outcomes and reduced costs in managing other pediatric chronic diseases and heart failure in adults, but the treatment and cost implications of programs for managing pediatric cardiomyopathy are unknown. We investigated the treatment and cost implications of establishing such programs by reviewing cost-effectiveness studies of similar programs, estimating the current inpatient costs of this diagnosis, and interviewing experts in the field about the need and desirability of these programs. According to our findings, comprehensive pediatric heart failure programs do exist, but they have not been evaluated or even described in the literature. Consensus among experts in the field is that comprehensive chronic care programs are highly desirable, and similar programs have reported tremendous cost savings through early and intensive management: the return on investment has been as high as 22 to 1. Another study reported that mean length of stay decreased from 83.9 to 10.6 days, mean annual admissions decreased from 2796 to 1622, and median hospital charges decreased from $26.1 million to $14.6 million. In conclusion, limited experience and strong circumstantial evidence suggest that, despite substantial costs, comprehensive multidisciplinary pediatric heart failure programs would be cost-effective and beneficial to patients, families, and institutions alike.
AB - Substantial numbers of children with cardiomyopathy are now surviving into adulthood, making it essentially a chronic disease. As a chronic condition, it may be best treated through comprehensive, multidisciplinary treatment programs. Such programs have improved health outcomes and reduced costs in managing other pediatric chronic diseases and heart failure in adults, but the treatment and cost implications of programs for managing pediatric cardiomyopathy are unknown. We investigated the treatment and cost implications of establishing such programs by reviewing cost-effectiveness studies of similar programs, estimating the current inpatient costs of this diagnosis, and interviewing experts in the field about the need and desirability of these programs. According to our findings, comprehensive pediatric heart failure programs do exist, but they have not been evaluated or even described in the literature. Consensus among experts in the field is that comprehensive chronic care programs are highly desirable, and similar programs have reported tremendous cost savings through early and intensive management: the return on investment has been as high as 22 to 1. Another study reported that mean length of stay decreased from 83.9 to 10.6 days, mean annual admissions decreased from 2796 to 1622, and median hospital charges decreased from $26.1 million to $14.6 million. In conclusion, limited experience and strong circumstantial evidence suggest that, despite substantial costs, comprehensive multidisciplinary pediatric heart failure programs would be cost-effective and beneficial to patients, families, and institutions alike.
KW - Comprehensive programs
KW - Multidisciplinary programs
KW - Pediatric cardiomyopathy
KW - Pediatric heart failure
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U2 - 10.1016/j.ppedcard.2007.11.011
DO - 10.1016/j.ppedcard.2007.11.011
M3 - Article
AN - SCOPUS:40949084269
VL - 25
SP - 103
EP - 111
JO - Progress in Pediatric Cardiology
JF - Progress in Pediatric Cardiology
SN - 1058-9813
IS - 1
ER -