Date of Award

January 2011

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

Department

Medicine

First Advisor

Marjorie S. Rosenthal

Subject Area(s)

Medicine

Abstract

GROUP WELL CHILD CARE: AN ANALYSIS OF COST. Hiromi Yoshida, Ada M. Fenick, Marjorie S. Rosenthal. Section of General Pediatrics, Department of Pediatrics, Yale University, School of Medicine, New Haven, CT.

Group well child care is an innovative way to conduct health supervision visits that may allow pediatricians to better serve the needs of patients and their families. Outcomes of child development, maternal mental health, and emergency department utilization in group care are similar to those of individual care. Group well child care will be sustainable in practice only if it is cost neutral or cost saving.

The objective of this project was to examine the optimal arrangement of a group well child visit (WCV) by varying the combinations of healthcare providers and group size to ensure that the visit was cost neutral or cost saving when compared to an individual WCV.

We created economic models using administrative data and Bureau of Labor statistics to evaluate the costs of an individual WCV delivered by an APRN, a resident physician, and an attending physician and 3 different group WCV models. The three group visit models were: 1. APRN model facilitated by an APRN, with a nurse and social worker; 2. Resident physician model facilitated by a resident physician, with assistance from an attending physician, nurse, and child life specialist; and 3. Attending physician model facilitated by an attending physician with a nurse. We varied physician salary and fixed other healthcare provider salaries.

Using the respective individual WCV cost as a breakeven point, we performed sensitivity analyses on group size (number of parent-child dyads) and length of time each ancillary healthcare provider could participate in the group visit to determine the ideal combination of factors that would make a group visit model cost neutral with an individual WCV.

The cost of an individual WCV conducted by an APRN was $20.51, one by a resident physician was $17.81, one by an attending physician with a low salary was $15.58, and one by an attending physician with a high salary was $20.49. We achieved cost-neutrality in the group model at four parent-child dyads in the APRN model; we achieved cost-neutrality at three, four, five, and six dyads in the resident physician model with, respectively 30, 45, 60 and 90 minutes of attending supervision; and we achieved cost-neutrality at four dyads in the attending model with a low salary, and at five dyads in the attending model with a high salary.

In conclusion, group well child care can be delivered by APRNs, resident physicians, and attending physicians in a cost neutral manner by optimizing group size and contributions made by nurses, socials workers, and child life specialists. Future research should further explore the clinical benefits that group well child care offers so that a cost-benefit or cost-effective analysis can be conducted.

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This is an Open Access Thesis.

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