The following is a guest article by Tammi Jantzen, Co-Founder & CFO at Astarte Medical
Medical advances have led to improved survival for many previously life-threatening conditions of childhood, such as prematurity, congenital anomalies (like congenital heart defects), and congenital or acquired brain injury (like cerebral palsy). Technological advances such as ventilator support, feeding tubes and transplantation have successfully prolonged the lives of children with lung, gut, and other organ failure. This epidemiological shift has created a growing population of children with medical complexity (CMC)—children with significant chronic health conditions that involve multiple organ systems, substantial health service needs, major functional limitations, and high health resource utilization. CMC has created a new population that requires specialized care delivery to meet their complex healthcare needs.
High Risk of Inappropriate Care
Although CMC comprises <1% of all U.S. children, they account for an estimated 30% of all pediatric health care costs and 86% of hospital charges in U.S. children’s hospitals. In the past decade, hospitalizations for children with chronic conditions have increased nationally by 33%. Several factors have contributed to the increase in prevalence of CMC, including improvements in survival rates of extremely preterm infants and other critically unwell newborn infants who are now surviving into childhood and beyond, but with increased rates of neurodevelopmental disability and chronic conditions. Patterns of CMC hospital care have demonstrated substantial vulnerabilities, such as a high risk of hospital readmission, total and preventable adverse events, and unnecessary variation in hospital care. Unfortunately, these children are at a high risk of missed, fragmented, and/or inappropriate care.
Protocols Exist But Are They Being Followed?
Many clinical practice groups have developed consensus-based protocols and clinical pathways to detail the steps in a course of treatment or care plan to standardize care for a specific clinical problem, procedure, or encounter. Protocol-driven care can guide the medical team and reduce practice variation, improve quality of care, and optimize CMC outcomes. This process can help clinicians to utilize the latest scientific evidence and aid in clinical decision making.
However, simply establishing a protocol does not necessarily mean clinical teams are implementing it into their workflow. To be truly effective, its utilization needs to be monitored for compliance and effectiveness. Today, there is no practical way to evaluate adherence to protocols or to measure their effectiveness to improve the practice of care. Protocol implementation and management is still a manual, self-reported process. It requires critical resources to access and analyze comprehensive EMR data – which is often time and cost prohibitive – therefore the utilization and effectiveness of many protocols and care plans for CMC remain unknown.
Embracing Innovative Digital Tools is the Solution
Fortunately, innovative technology can overcome the challenges of data acquisition from the EMR and manual evaluation of protocol adherence or lack thereof. Clinical practice groups can benefit from operational tools that harness data directly from the EMR, digitize clinical protocols, monitor and promote compliance, and more effectively analyze the correlation of compliance with outcomes. With data as the common denominator, tech-enabled digital tools allow healthcare providers and health system administrators to measure and track compliance with clinical protocols and understand how clinical decisions correspond to short and long-term outcomes for children with medical complexity.
For example, survival rates for preterm infants continue to improve. Attention is now focused on improving the quality of survival through optimal nutrition management. Yet, optimizing feeding and nutrition management in the neonatal intensive care unit (NICU) remains a major challenge for clinicians. Solving this challenge requires a real-time, clinical decision support solution that enables NICU clinical care teams to standardize and streamline the practice of feeding and nutrition management for preterm infants. It must also allow for a flexible integration with the EMR, resulting in full access to historic and real-time patient-level or unit-wide data, displayed in intuitive, structured dashboards. A hospital’s own feeding protocol should be digitized and embedded into patient care workflows. Providers require a dashboard display of feeding, nutrition and growth-related data to analyze the best care pathways. This data, and corresponding analytics, should provide easy real-time data review, as well as easy export and analysis to facilitate research and quality improvement initiatives. It’s not an easy undertaking but is imperative to realizing the potential of standardizing care.
Using data analytics and digital tools to measure historical practices and prospectively measure and monitor outcomes for CMC will lead to improved, evidence-based patient care. As the industry gets better at using data analytics in decision making and automation finds more mainstream uses in operational, administrative, and clinical settings, the potential for optimal standardization for these vulnerable children will accelerate.
About Tammi Jantzen
Tammi Jantzen is Co-Founder and CFO at Astarte Medical, a clinical intelligence company providing digital solutions to support nutrition and feeding practices and protocol-driven care across pediatric populations. Its first product, NICUtrition® improves growth and clinical outcomes for preterm infants and impacts critical performance metrics for hospitals. Tammi is passionate about delivering digital solutions with real clinical utility that make a difference in the lives of our most vulnerable children.
