Dr. Tantoco
Presenter: Mike Tchou, MD, MSc, Children’s Hospital of Colorado/University of Colorado-Anschutz Medical Campus, Aurora, Colo.
Dr. Tchou began by defining value as an equation, with value equaling the sum of outcomes, patient experience, and equity, divided by the sum of cost and input. He emphasized that child health care spending has greatly increased in the U.S. and can result in inefficient systems, burnout, and preventable harm.
He applied the value equation to a case of a five-day-old, healthy, term newborn with elevated bilirubin in the high-risk zone. An outpatient pediatrician requested hospital admission for this infant with a bilirubin of 19.2 on a Friday night for fear of the bilirubin increasing with the need for phototherapy prior to Monday. This ensured a discussion with the audience on how to best care for this infant. Dr. Tchou discussed that kernicterus usually occurs when total serum bilirubin is over 40 mg/dL with more than two neurotoxicity risk factors. In addition, phototherapy may increase the risk of cancers and seizures. Phototherapy may also decrease the rate of breastfeeding and can cause stress and anxiety to parents and caregivers. Hospitalization for phototherapy also results in medical and non-medical costs for the families. He highlighted that one should not initiate phototherapy in term or late-term well-appearing infants who have bilirubin levels below the American Academy of Pediatrics guideline threshold for treatment. This recommendation is one of those in “Choosing Wisely in Pediatric Hospital Medicine: 5 New Recommendations to Improve Value,” published in Hospital Pediatrics.
He ended the talk by stating that there are several opportunities to bring high-value care to our pediatric patients. He provided a list of high-value care resources, which included cost data, articles, journals, textbooks, and national organizations.
Key Takeaways
- Value is an important concept in pediatric hospital medicine and can be defined as an equation, which includes patient outcomes, patient experience, equity, and cost.
- The Choosing Wisely campaign provides recommendations on how hospitalists can improve the care of hospitalized children.
- Many opportunities are available to help provide high-value care to pediatric patients.
Dr. Ann-Marie Tantoco is an academic med-peds hospitalist at Northwestern Memorial Hospital and Ann & Robert H. Lurie Children’s Hospital of Chicago. She is an instructor of medicine and pediatrics at Northwestern University Feinberg School of Medicine, Chicago, and an executive council member of the SHM Pediatric Special Interest Group.